BOILS.
These are always due to the introduction of Staphylococcus pyogenes ctureus to a hair follicle or sebaceous gland, and the preventive and curative treatment of furunculosis by Vaccine therapy may be relied upon. too million staphylococci administered to a patient developing an isolated furuncle always produce an immediate positive phase and arrest its development, whilst 30o million three or four days later reinforce the action of the previous dose, and put an end to the furuncle. Hence the treatment of recurring furunculosis is practically identical with that of acne, and the older methods of administering Sulphide of Calcium, Arsenic, Yeast, Nucleinic Acid, Quinine, Iron, &c., are abandoned in all chronic cases. Constitutional treatment, however, is not devoid of value, especially when boils continue to form in subjects suffering from diabetes, chronic Bright's disease, gout, or other serious organic conditions, which lower the resistance to the cocci. J. and R. Reynolds have reported excellent results from the administration of full doses of Dilute Sulphuric Acid every four hours in all cases not complicated by glycosuria.
When an isolated boil shows itself an attempt may be made to cause its abortion by the use of local antiseptics. The skin over the summit of the inflamed cone should be scraped gently till a minute trace of blood exudes. or the hair may he !thicket.] out of the congested follicle, and strong Carbolic Acid. Nitrate of li..n.ury solution, or Iodised Phenol upon the point of a sharpened end of a piece of matchwood, or a fine caustic point, should be thrust into the centre of the small circumscribed swelling. Some surgeons inject a few drops of Carbolic Acid or weak Tincture of Iodine by a hypodermic syringe. .1fter this has been done the part may be brushed over with Collodion, Nitrate of Silver solution. lehthyol and Glycerin (i in 2). or Thiol, or covered with it piece of lint soaked in a solution of Chloral Hydrate in glycerin and water (t in 4), or with a cony press soaked in saturated solution of Rorie Acid. When much pain is felt the Green Extract of Belladonna, rubbed up with an equal amount of Glycerin, may be smeared over it.
Sometimes the application of a piece of warmed Belladonna, Opium, Salicylic, or Mercurial Plaster, with a small circular aperture in the middle laid over the developing furuncle, causes its abortion, but when the surrounding skin is already infected new furuncles may appear under the plaster.
~chide an:usthetises the boil with 3 per cent. Novocain till a wheal forms, then injects c e.e. of the solution slowly into the centre, and destroys it thoroughly by the point of the Paquelin cautery.
Where suppuration has already occurred a little strong Carbolic .1cid may he brushed over the part to destroy the sensibility of the skin, or Cocaine or freezing may be resorted to, and the boil incised with a sharp abscess-knife. For large boils, and for carbuncles which are of the same
nature as furuncles, sometimes the cavity or core is swabbed with strong Carbolic Acid, but upon the whole it is better after incision to wash the cavity with I lydrogen Peroxide and to apply a poultice to assist nature in the separation of the slough or central core. The old linseed eataplasni can only he kept sterile with great difficulty, and since asepsis is essential the best poultice consists of several layers of lint soaked in a warm saturated solution of Boric Acid and renewed frequently. This or any other liquid application should not be covered in with oiled silk; the retained secretion and sweat are liable to bring out further crops of boils around the skin beyond the margins of the lint. Where an evaporating lotion is indicated Rectified Spirit (i in 3) may be applied. Salwedcl's method is a compromise between poulticing and applying evaporating lotions; he lays over the part layers of lint or wool saturated with alcohol, and covers these in with oiled silk perforated by small openings.
Boric .k cid Ointment is a good routine application as soon as the con tents have been evacuated, and antiseptic ointments, as a rule, are better than aqueous solutions. Ibtsilicon Ointment is a valuable application %, hen the healing is slow. A smart saline purge is always beneficial when the suppurative process is in the stage, and the tension of the parts causes throbbing and constitutional discomfort, or fever.
During the healing process, Quinine and Iron, Yeast or Sulphides, and appropriate strengthening diet as strong soups, &c., may be administered, and onions may be freely partaken of. The closest attention should be given to the cleansing of the skin by antiseptic baths, especially in the recurring form of the disease, even when vaccine treatment is resorted to. Bowen insists upon a sterilisation of the skin after a warm bath by spong ing the entire body with saturated Boric Solution which is permitted to dry spontaneously. The writer prefers a bath deeply coloured by Permanganate of Potassium. The clothing and bed-clothes should be frequently changed.
In the troublesome. furunculosis affecting the external auditory canal the writer finds that the best routine treatment consists in the instillation of the official Liq. Hvdrarg. Perchlor., and the loose plugging of the meatus with wool saturated by the same liquid. Grosch uses solution of Acetate of Alumina (1 in 4). Where the boils are already discharging into the meatus, Boric Acid powder may be instifilated.
The treatment of Carbuncle will be described under its own heading.