While boils are frequently met with in debilitated persons, and particularly in those suffering from diabetes or Bright's disease, they also occur in those who enjoy vigorous health. They seldom prove dangerous to life except in diabetic subjects, but when they occur on the face there is a risk of lymphatic and of general pyogenic infection. Boils may be differentiated from syphilitic lesions of the skin by their acute onset and progress, and by the absence of other evidence of syphilis; and from the malignant or anthrax pustule by the absence of the central black eschar and of the circumstances which attend upon anthrax infection.
Treatment.—The skin of the affected area should be painted with iodine, and a Klapp's suction bell applied thrice daily. If pus forms, the skin is frozen with ethyl-chloride and a small incision made, after which the application of the suction bell is persevered with. The further treatment consists in the use of diluted boracic or resin ointment. In multiple boils on the trunk and limbs, lysol or boracic baths are of service; the underclothing should be frequently changed, and that which is discarded must be disinfected. In patients with recurrence of boils about the neck, re-infection frequently takes place from the scalp, to which therefore treatment should be directed.
Any impaired condition of health should be corrected; when, there is sugar or albumen in the urine the conditions on which these depend must receive appropriate treatment. When there are successive crops of boils, recourse should be had to vaccines. In refractory cases benefit has followed the subcutaneous injection of lipoid solution containing tin.
Carbuncle may be looked upon as an aggregation of boils, and is characterised by a densely hard base and a brownish-red discoloration of the skin. It is usually about the size of a crown-piece, but it may continue to enlarge until it attains the size of a dinner-plate. The patient is ill and feverish, and the pain may be so severe as to prevent sleep. As time goes on several points of suppuration appear, and when these burst there are formed a number of openings in the skin, giving it a cribriform appearance; these openings exude pus. The different openings ultimately fuse and the large adherent greyish-white slough is exposed. The separation of the slough is a tedious process, and the patient may become exhausted by pain, discharge, and toxin absorption. When the slough is finally thrown off, a deep gap is left, which takes a long time to heal. A large carbuncle is a grave disease, especially in a weakly person suffering from diabetes or chronic alcoholism; we have on several occasions seen diabetic coma supervene and the patient die without recovering consciousness. In the majority of cases the patient is laid aside for several months. It is most common in male adults over forty years of age, and is usually situated on the back between the shoulders. When it occurs on the face or anterior part of the neck it is especially dangerous, because of the greater risk of dissemination of the infection.
A carbuncle is to be differentiated from an ulcerated gumma and from anthrax pustule.
Fig. 95.—Carbuncle of seventeen days' duration in a woman æt. 57.
Treatment.—Pain is relieved by full doses of opium or codein, and these drugs are specially indicated when sugar is present in the urine. Vaccines may be given a trial. The diet should be liberal and easily digested, and strychnin and other stimulants may be of service. Locally the treatment is carried out on the same lines as for boils.
In some cases it is advisable to excise the carbuncle or to make incisions across it in different directions, so that the resulting wound presents a stellate appearance.