Carbuncles differ from boils in being much larger, in having rounded or flat tops instead of the conical shape of boils, in having numerous, sievelike openings, in the occurrence of death of the skin over the top of the carbuncle, and in being accompanied by intense pain and high fever.
Treatment.—Carbuncle demands the earliest incision by a skilled surgeon, as it is only by cutting it freely open, or even removing the whole carbuncle as if it were a tumor, that the best results are accomplished. However, when a surgeon cannot be obtained, the patient's strength should be sustained by feeding every two hours with beef tea, milk and raw eggs, and with wine or alcoholic liquors. Three two-grain quinine pills and ten drops of the tincture of the chloride of iron in water should be given three times daily.
The local treatment consists in applying large, hot, fresh flaxseed poultices frequently, with the removal of all dead tissue with scissors, which have been boiled in water for ten minutes. When the pain is not unbearable, dressings made by soaking thick sheets of absorbent cotton in hot solution of corrosive sublimate (1 to 1,000 as directed under Boils, p. [161]) should be applied and covered by oil silk or rubber cloth and bandage. They are preferable to poultices as being better germ destroyers, but are not so comfortable. When the dead tissue comes away and the carbuncle presents a red, raw surface, it should be washed twice a day in the 1 to 1,000 corrosive-sublimate solution, dusted with pure boric acid, and covered with clean, dry absorbent cotton and bandage.
ECZEMA; SALT RHEUM; TETTER.—Eczema is really a catarrhal inflammation of the skin, with the exudate (fluid that escapes) concealed beneath the surface, or appearing on the surface after irritation has occurred. The many varieties are best classified as follows:
(1) Eczema of internal origin, including cases due to morbid agencies produced within the body, cases due to drugs, and possibly reflex cases.
(2) Eczema of external origin, including cases caused by occupation, by climate, or by seborrhea.
Eczema of internal origin almost invariably appears on both sides of the body at once, as on both cheeks, or both arms, or both thighs. Its border shades into the surrounding skin, it is dotted with papules (or heads) filled with fluid, and its surface is clean and not greasy. As it spreads, the symmetry of distribution is lost. Among the morbid agencies producing this variety of eczema are the products of indigestion. Among the drugs producing it is cod-liver oil.
Occupation eczema occurs first on exposed parts, as the hands, arms, face, and neck, in those who handle irritant dyes, sugar, formalin, etc.
Climatic eczema includes the "winter itch," common in this latitude, appearing on wrists and ankles in the form of clean, scaly patches, often ringed.
The seborrheic variety spreads from the scalp to the folds of the skin. Its borders are sharply defined, and its crusts and scales yellowish and greasy. It spreads from a center in all directions at once.