. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. tion of theneighboring parts. Lymphangitis and lymphade-nitis are generally present. The affection is accom-panied by severe pain, high fever and rigors. Carbuncle is generally caused by streptococcalinfection. Eczema and other affections of the skinwhich cause furuncle, may also give rise to , furuncle may develop into carbuncle,especially when the core has been forcibly expressed,or when hot fomentations have been applied. Indiabetics carbuncle is still more common
. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. tion of theneighboring parts. Lymphangitis and lymphade-nitis are generally present. The affection is accom-panied by severe pain, high fever and rigors. Carbuncle is generally caused by streptococcalinfection. Eczema and other affections of the skinwhich cause furuncle, may also give rise to , furuncle may develop into carbuncle,especially when the core has been forcibly expressed,or when hot fomentations have been applied. Indiabetics carbuncle is still more common than fur-uncle, and leads to extensive necrosis of the fascia;it often causes death from exhaustion. Carbuncle ofthe face is dangerous owing to its liability to causegeneral infection, or meningitis by infection of thefacial vein. Carbuncle of the nape of the neck mayattain enormous size, and extend from one ear to theother. Differential Diagnosis. Anthrax (malignantpustule) differs from carbuncle in the presence ofsmall vesicles .filled with turbid fluid and early cen- 202 Bockenheimer, Atlas. Tab. Fig. 8Q. Carbunculus. Rcbman Company, New-York. tral necrosis of the skin, and in the absence of doubtful cases a bacteriological examination mustbe made. Treatment. Under an antesthetic, a crucial inci-sion is made through the whole extent and depth ofthe carbuncle, and the central necrosed parts wound is plugged with iodoform gauze. In diabetic carbuncle, progressive neciosis of thefascia often necessitates counter-incisions. Iodoformgauze should not be used in these cases, but sterilegauze. Special treatment is required for the diabetes. In every carbuncle there is severe constitutionaldisturbance which requires general treatment bynourishing diet, etc. Fig. 90 shows a carbuncle of the nape of the neckin a patient of forty. The infiltration is very exten-sive. In the central parts the skin is ruptured inseveral places, and shows the deeply situated, ne
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