Anthrax or Carbuncle

Is a multiple furuncle. It arises as a hot, hard swelling, not so conical as that of the boil - more indurated, however, the cellular tissue around being much more extensively indurated; its color is dusky, the sensation burning, dull, throbbing; the carbuncle varies in size, the swelling becomes "brawny", from the meshes of the cellular tissue becoming filled with a plastic lymph. The next step is the formation of a quasi-abscess; the central part of the swelling softens, and feels boggy; the skin becomes thin over the surface, and at several points openings occur, through which slowly issues more or less sanious pus; and the little holes are seen to be plugged up by small white cores, which presently loosen and come away; the apertures are red and papillated, the edges indurated and everted, particularly when several openings coalesce, so as to form one or more large openings. Gangrene may set in. The healing process is often indolent, the parts remaining undermined, brawny, dusky, shreddy, and also sloughly. Carbuncles are generally solitary. The patient, if the attack be severe, gets into a very depressed state. The posterior aspect of elderly people is the selective seat of carbuncle.


In carbuncles there are similar changes to those in boils, but a much severer degree of disease. Here a group of sebaceous glands is involved, and in consequence of the more cachectic state of the nutrition the reparative attempt is less perfect, the inflammation is of a lower type, and the cellular tissue sloughs and dies to a much greater extent. The nutrition is not only unequal to prevent the local disorder, but also incapable of putting repair in proper operation; and there is one disposition in carbuncular sub­jects that perhaps has a peculiar influence in disposing to sloughing and gangrene of the cellular tissue; this is the tendency to, or an actual, diabetic habit. Sugar occurs in the pus of the carbuncle, and it is a curious fact that when anthrax develops the sugar is diminished or disappears from the urine.


In summing up the conditions under which boils occur, it will not be difficult to classify the main ones as follows:

1. during seasonal changes in spring and summer;
2. from eating diseased meal (frozen);
3. when any special alteration is made in the ordinary habits and economy of the body, as in the training of prize-fighters;
4. from the influence of cadaveric poisons;
5. from sudden change of diet;
6. after fatigue of long duration;
7. during convalescence from debilitating diseases;
8. as a consequence of the action of septic poisons, as in fevers, etc.;
9. in albu-minuria;
10. in the diabetic habit;
11. during adolescence, and in the first stage of manhood.

In most of these cases there are "debility" and an overloaded state of system, for example, the circulation of urea, of sugar, of septic poison, or of effete matter which is plentiful during convalescence; and it only needs the action of some local irritant to determine the development of furunculi in the parts to which that irritant is applied.