—In the treatment of these lesions, so long as they are mild, the surgeon should confine himself to soothing applications and rest; at the same time discontinuance of x-ray exposures and even avoidance of light seem to be essential. Any operator threatened with such trouble should wear thick rubber gloves during all his work. The local treatment of this lesion is not essentially different from that described in the chapter on Ulcers and Ulceration, but the surfaces are often so erethistic as to demand either anodyne applications, containing such remedies as orthoform, anesthesin, or even cocaine, or else they need radical treatment with a sharp spoon.
Sloughing surfaces should be treated with brewers’ yeast until the surface has become healthy. Picric acid in solution has been recommended, a saturated solution being diluted seven or eight times before using.
The writer has rarely seen any more distressing or obstinate lesions than presented in some of these cases. In speaking of epithelioma it has been stated that some of these ulcers are prone to thus degenerate. It seems an extreme contradiction in physics that the agent used so frequently in the treatment of superficial cancers should, when used to excess, produce lesions which themselves become cancerous. It has been the writer’s privilege to witness amputation of all of one hand and a large part of the other, in the case of a well-known colleague, who carried the x-ray treatment to excess, and until he suffered to this extent. Careful and discriminating judgment is therefore necessary in the management of vacuum tubes.
Since radium has come into use it has been found to exercise a deleterious effect upon the skin. The radium emanations are known to influence living cells and tissues, and their inhibiting effect upon the growth of larvae has been well established. The prohibitive price of radium preparations will make these lesions rare. After exposure there appears an erythema followed by an active dermatitis, which so closely resembles lesions above described, in their early stages, that one description will suffice for both. Moreover, the treatment of a radium burn differs in no essential respects from that of an x-ray burn.
ACUTE INFECTIONS OF THE SKIN.
Furuncle or Boil.
—A furuncle is a phlegmon having its origin in a hair follicle and involving a small area of skin and subcutaneous tissue. The infection is produced by one of the ordinary pyogenic organisms, which have easy access to the base of the follicles. Sometimes these organisms are of unusual virulence, but ordinarily there is a local condition which favors the infection, while it may be encouraged by a general diathetic condition, such as diabetes. The lesion is usually single, but may be multiple. Boils appear sometimes in groups or in crops, and when the condition has become chronic it is called furunculosis, which may be local or general. A boil commences as a tender papule, which rapidly enlarges into a conical swelling, sometimes of considerable size. Around it there is an area of dusky discoloration, while the apex becomes quite dark. Pus, travelling in the direction of least resistance, comes more or less readily to the surface, the apex of the boil yielding and pus finally escaping, if not evacuated by incision, usually with a small amount of necrotic tissue, which may be sufficiently large to justify the term “core.” With the escape of pus the throbbing pain is much relieved. A furuncle arising in tissues where swelling is not easily treated, as in the nose, the external meatus, and also in the axilla and the perineum, will produce an abnormal amount of pain.
Treatment.
—The domestic treatment of boils consists of poultices, usually made of hot flaxseed. These are always nauseous applications, and tend to favor the development of similar trouble in adjoining follicles. An equally comforting application can be made with a piece of spongiopiline, or a compress, saturated in an antiseptic solution, and covered with rubber tissues, outside of which, if necessary, a hot-water bottle may be applied. Inasmuch as it is tension which produces pain, early incision, which can be made under a little freezing spray, or with cocaine, will give the greatest relief. This may be practised even before pus has appeared. After such incisions the same moist applications may be applied. Incisions should be made as soon as pus is shown to be present. The appearance of a whitish point at the apex of the furuncle will always indicate the presence of pus beneath.
General furunculosis has almost always an underlying diathesis as a cause, and this should be sought out and treated according to its nature. In the absence of recognized constitutional conditions the writer has never found anything equal to aromatic sulphuric acid, given in 10 or 12-drop doses, with tincture of arnica in teaspoonful doses, to be freely diluted with water.