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frayed collars and sweaters, etc., boils are likely to occur. Also when the face and neck are handled by barbers with dirty hands or instruments, a fruitful field is provided for their invasion. While boils are always the result of pus germs gaining entrance to the skin glands, and, therefore, strictly due to local causes, yet they are more prone to occur when the body is weakened and unable to cope with germs which might do no harm under other circumstances.
The conditions favoring the occurrence of boils are: an impoverished state of the blood, errors of diet and indigestion, overwork, dissipation, and certain diseases, as typhoid fever, diabetes, and smallpox. Boils are thought to occur more frequently in persons with rough skin and with a vigorous growth of dark hair. They may be situated on any part of the body, but certain localities are more commonly attacked, as the scalp, the eyelids, cheeks, neck, armpits, back, and buttocks. Boys and young men are generally the sufferers.
Treatment. The importance of cleanliness cannot be overestimated in the care of boils if we keep their cause in mind. Dirty underclothes or fingers used in squeezing or otherwise handling the boil, may carry the trouble to fresh parts. Any sort of local irritation should be removed; also all articles of clothing which have come in contact with the boils should not be worn until they have been washed in boiling water. There is no single remedy of much value for the cure of boils, although pills of calcium sulphide (each one
tenth grain) are commonly prescribed by physicians, every three hours.
The most rational measure consists in removing the general causes, as noted above, if this is possible. When the patient is thin and poorly nourished, give food and cod-liver oil; and if the lips and skin are pale, iron arsenate pills (one-sixteenth grain each) are to be taken three times daily for several weeks. A boil may sometimes be arrested by painting it with tincture of iodine until the boil is almost black, or with a very heavy coating of collodion. If a boil continues to develop, notwithstanding this treatment, one should either use an ointment of vaseline containing ten per cent of boric acid spread on soft cotton over the boil, or, if the latter is very painful, resort to the frequent application of hot flaxseed poultices.
When the boil has burst, and pus is flowing out on the surrounding skin, it should be kept very clean by frequent washing with hot water and soap and the application of a solution of corrosive sublimate (one part to 1,000) made by dissolving one of the tablets, sold everywhere for surgical purposes, in a pint of warm water. This will prevent the lodgment of the pus germs in the skin and the formation of more boils. Poultices mixed with bichloride (corrosive sublimate) solution are less likely to encourage inoculation of neighboring areas.
The poultices should be stopped as soon as the pain ceases, and the boil dressed as recommended above,
dusted with pure boric acid and covered with clean absorbent cotton and bandage. After pus has begun to form in a boil recovery will be materially hastened by the use of a knife, although this is not essential. The boil should be thoroughly cleaned, and a sharp knife, which has been boiled in water for five minutes, is inserted, point first, into the center of the boil, far enough to liberate the pus and dead tissue. By this means healing is much more rapid than by nature's unassisted methods. Pure carbolic acid, applied on the tip of a toothpick, thrust into the head of a boil, is generally curative. When many boils occur, consult a physician.
CARBUNCLE.-A carbuncle is similar to a boil in its causation and structure, but is usually a much more serious matter having a tendency to spread laterally and involve the deeper layers of the skin. It is commonly a disease of old persons, those prematurely old or debilitated, and occurs most frequently on the neck, back, or buttocks. It is particularly dangerous when attacking the back of the neck, upper lip, or abdomen.
Carbuncle often begins, with a chill and fever, as a pimple, and rapidly increases in size forming a hot, dusky red, rounded lump which may grow until it is from three to six inches in diameter. Occasionally it runs a mild course, remains small, and begins to discharge pus and dead tissue at the end of a week and heals rapidly. More commonly the pain soon becomes
intense, of a burning, throbbing character, and the carbuncle continues to enlarge for a week or ten days, when it softens and breaks open at various points discharging shreds of dead tissue and pus. The skin over the whole top of the carbuncle dies and sloughs away, leaving an angry-looking excavation or craterlike ulcer. This slowly heals from the edges and bottom, so that the whole period of healing occupies from a week to two, or even six months. The danger depends largely upon blood poisoning, and also upon pain, continuous fever, and exhaustion which follow it. Sweating and fever, higher at night, are the more prominent signs of blood poisoning.
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
(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