REPORT OF A CASE OF CARBUNCLE 
OCCURRING IN MR. SYME’S PRACTICE, ILLUSTRATING 
ESPECIALLY THE PATHOLOGY OF THAT DISEASE 
[Monthly Journal of Medical Science, July 1854.] 
THOMAS DAVIDSON, aet. 52, admitted into the Royal Infirmary, February 9, 
1854, a weaver, residing at Sinclairton near Kirkcaldy. States that he has 
generally enjoyed good health, and that three weeks before his admission he 
was in no respect worse than usual; he had been in full work and had eaten 
and drunk his usual quantity without excess in either respect. At this time 
his attention was directed by a sensation of itching to the back of his right 
shoulder, and on putting his finger to the part, he found a small elevation about 
as big as a barley-corn and very tender to the touch. This grew rapidly and 
became the seat of intense pain, and continued to increase in size till his admis- 
sion, but had been less painful for a few days preceding it. When he came 
to the Infirmary a large elevated mass existed behind the right shoulder, of 
circular form, about six inches in diameter, rising gradually from the level of 
the skin around: of livid red colour surrounded by brighter redness of an inch 
or two of the adjacent skin. Its circumferential part was of brawny consistence, 
while the central part was soft and pulpy, but not fluctuating, and in this central 
part there were numerous small circular apertures, which did not admit the 
probe for more than a very short distance; the instrument could be passed 
a little way under their margins, which were formed by a vascular superficial layer 
as thin as paper. At the centre of the tumour these openings were confluent. 
On the day of the patient’s admission Mr. Syme made a very free crucial 
incision through the tumour, extending down to its very base, and reaching a 
little way into the bright red surrounding skin. A good deal of bleeding occurred, 
and the colour of the tumour became rapidly and very remarkably changed to 
a pale bluish-red tint. The cut surface, which in the centre measured nearly 
two inches perpendicularly, presented numerous small collections of pus scat- 
tered through it, and many spots of yellow lymph; the rest of the tissue was 
evidently the dermis expanded by the inflammatory exudation, and towards 
the centre of the tumour in a shreddy sloughy state. The patient was not 
under chloroform, and says he hardly knows whether the pain of the incisions 
was worse than that which he had suffered from the carbuncle a few days before 
admission. Mr. Syme ordered milk diet, which has been gone on with to the 
present time (February 14), while linseed-meal poultices have been applied 
twice a day. Under this treatment the carbuncle has daily improved, induration 
diminishing and the mass melting down, partly in the state of slough and partly 
in that of pus; the surrounding redness is almost totally gone, no extension 
whatever of the disease having occurred since the incisions were made. The 
pale tint of the skin that occurred at the time of the incisions never became 
deepened, except at one part, where the interval between the incisions was 
greater than elsewhere, and there it remained red and hard for a day or two ; 
but there also the free drain afforded by the incisions has some days ago removed 
