The Treatment of Carbuncles.

During the last few years the treatment of carbuncles has often been discussed, and many different procedures advocated, ranging from the local application of cod-liver oil or insulin to the injection of staphylococcal toxoid. Without denying the good effect of many of the forms of treatment recommended, it is important that the question be considered from a rational standpoint. In the first place, it must be realized that a carbuncle is an infective gangrene of the subcutaneous fat, the organism concerned is nearly always the Staphylococcus aureus, and the infection almost always occurs via the blood stream. It is important to emphasize these elementary, and generally accepted pathological facts because a consideration of them has an important bearing on the treatment of the condition. The occurrence of a carbuncle usually implies that the patient's resistance is low, and the possibility of diabetes or chronic nephritis being present at the same time must always be considered. Classification of Carbuncle. Carbuncles occurring on the face and carbuncles complicating diabetes stand in a class by themselves and are of such great importance that they will be considered subsequently in detail. The remaining carbuncles, which form the majority of those seen, fall ultimately into one of the following three groups:-(I) Localized " Non-toxic." (2) Localized "Toxic." (3) Spreading. This classification is arbitrary and when the patient first comes under observation it will be impossible to say to which group the case should be assigned. Conservative treatment must always be instituted in the first instance. Conservative Measures. General treatment consists in putting the patient to bed, administering large quantities of fluid by the mouth, and giving sedatives if the pain is great. Glucose and alcohol are both of value, and calomel followed by a saline purge may be required. Local treatment has two objects in view-first to increase the local blood supply, and secondly to encourage a transudate from the blood across the infected tissues.