_Anthrax_ or _Carbuncle_ maybe considered as a severe form of boils.
It occurs in the plague, and is a characteristic symptom. It appears
in the same parts, and apparently from the same causes, as the boil.
The tumour is of a more flattened form, slightly elevated above the
surface, and frequently of great extent; the base is deeply-seated,
hard, and unyielding. The integuments are at first of a bright colour,
but afterwards assume a dark-red or reddish-brown hue. The pain is
violent and burning. The process of suppuration is very tedious, and
the matter that is formed is small in quantity. If the tumour is not
interfered with, ulceration occurs in its surface, producing various
apertures, through which the matter is evacuated, the discharge is thin
and unhealthy, excoriating the neighbouring surface; and the mortified
cellular tissue, remaining at the base of the swelling, keeps up the
irritation. The extent of a carbuncle is frequently great, both as to
width and depth; on the back, or buttocks, it not unfrequently attains
an immense size. In one instance, the whole posterior part of the neck
was involved; the cellular tissue, muscles, and tendons, sloughed;
and the vertebræ were ultimately exposed. In another case, the whole
occiput, the posterior and lateral parts of the neck, and the space
betwixt the shoulders, exhibited one continuous mass of carbuncle. By
making free incisions, procuring early separation of the sloughing
parts, and supporting the strength of their constitutions, both
patients recovered, though considerably advanced in life.
It seldom occurs in the face or head, and when it does, it generally
proves fatal. In a male patient in the Edinburgh Royal Infirmary,
aged forty-eight, a carbuncle of the size of a very large orange
was situated in the centre of the forehead; by active local and
constitutional treatment, he soon got well.
The affection is sometimes attended with typhoid symptoms, rigors,
profuse perspiration, nausea, vomiting, disordered bowels, loss of
appetite, anxiety, restlessness, difficult respiration, palpitations,
faintings, pale-white tongue, low pulse, pale or turbid urine,
headache, giddiness, drowsiness, and, in severe cases, with delirium.
In old or exhausted patients, the prognosis is unfavourable.
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