FURUNCLES.—Affections originating in a hair follicle or in a gland of the skin, and generally due to uncleanliness. They are located especially on those parts of the skin which are subject to pressure or friction ; for instance, on the neck (resulting from narrow and stiff collars), on the shoulder (due to the pressure of the suspenders), and on the loins and hips (as a consequence of tight waist-bands). Furuncles are often caused also by improper water cures ; and sometimes they arise in connection with general affections, such as tuberculosis or diabetes mellitus Furuncles have nothing to do with impurity of the blood ; they are local inflammations only. As a rule several furuncles arise at the same time. The affected parts of the skin are red, inflamed, smooth, glistening, and painful. After a few days a point of pus develops in the centre of the in flamed part. This pus may be pressed out with clean hands, or the furuncle may be opened with a needle which has been previously heated over an alcohol flame. It is best to consult a physician as early as possible ; and such consultation is absolutely necessary if the furuncles are very large. This will best prevent serious consequences, such as supervention of ery sipelas, etc. As a result of an infection with the pus of an existing boil, new furuncles may develop upon adjacent portions of the skin. For this reason it is popularly and correctly maintained that " the occurrence of one boil is followed by seven others." In order to prevent further infections, it is therefore advisable to lead a temperate life and to attend carefully to the cleanliness of the skin.
Extremely numerous furuncles arc often observed in small children, especially in such as are scrofulous or debilitated by other diseases. These boils should be opened as early as possible by a physician, as neglect of the condition is very apt to result in extensive inflammations. Baths with disinfectants added to the water are also beneficial GALLA (NUTGALLS).—These are excrescences on various species of oaks, produced by puncture and the depositing of ova by certain insects (Cynilos). The galls contains a high percentage of tannic acid, and are used in medicine for much the same purposes as the latter ; namely, for astringent mouth-washes and douches, and occasionally in the treatment of subacute and mild diarrhteas.
GALL-STONES.—Stones which develop in the gall bladder or (occasion ally) in the liver. Ancient physicians regarded them as due to simple inspissation or drying up of the bile ; but at present the real cause is con sidered to be due to chemical changes in the bile, which in turn probably result from an inflammation of the mucous membrane of the gall-bladder. Three-fourths of all cases of gall-stones occur in women, generally after the fortieth year of age. This extreme frequency is undoubtedly related to the habit of wearing tight corsets which may obstruct the flow of the bile. Many physicians assume also that there exists a certain connection between pregnancy and the formation of gall-stones. People of sedentary habits often suffer from this complaint ; and it is ascribed also to over-eating (especially of meat) and to excessive use of alcoholic beverages. In certain districts the occurrence of gall-stones is very frequent, and has been ascribed to an abundance of lime in the drinking-water. Bacterial infection, especially typhoid, is an important causative factor ; and in certain families it seems that heredity also plays a part.
The size of gall-stones varies from that of a grain of sand to that of an egg. Sometimes only a single stone is found, but usually ten to fifteen small ones accumulate, and cases arc on record in which as many as one thousand and more have been found in one gall-bladder. The stones arc generally round or sharp-cornered (see Plate XIII., 2), although at times they are pear-shaped like the gall-bladder. Their surface may be either uneven or smooth, and their colours vary between all shades of green,.
brown, yellow and black. When fresh, they can be crushed between the fingers. Gall-stones are usually composed of the same materials which form the constituents of the bile : cholesterine, lime-salts, etc.
In some cases it happens that persons affected with gall-stones remain unaware of this fact, the stones being accidentally discovered at an autopsy. In other cases the patients suffer but slightly, and the stones are found in the excrements by mere accident ; this is especially often the case in the aged. The presence of gall-stones is generally recognised by attacks of so-called gall-stone colic. This colic is brought about en the stones, on leaving the gall-bladder, become engaged or stuck in their passage through the bile ducts. Such an attack may take place but once, or it may recur at varying intervals of months or years. Many persons become subject to such attacks after riding or dancing, or after vexation, but especially after eating too much. During the attack the patient is affected by a boring, burning, piercing, or crushing pain in the pit of the stomach or in the right side of the abdomen ; this pain may radiate into the right thigh and testicle, into the back, and into the right (rarely into the left) shoulder and upper arm. The pain, which is often all but unbearable, causes the face to become distorted with a look of fright, and the forehead to be covered with cold sweat. The patient presses his fist into the region of the liver, and leans forward with his knees bent ; often he writhes on the floor in his agony. The abdomen in the region of the liver is extremely sensitive to pressure ; and when the region of the gall-bladder is touched, the patient may scream with pain. Violent chills and fever, vomiting, hiccup, etc., are frequent manifestations of the affection. The stools are generally retarded, and the quantity of urine is scant. Unconsciousness is not an infrequent accompaniment of an attack. An attack generally lasts from three to five hours, and although it usually terminates favourably it is often followed by jaundice, Some patients have frequent attacks of gall-stone colic which may not be recognised as such ; and they are not infrequently treated for other affections In order to prevent the disease it is advisable to regulate the diet care fully, and to eat only simple food in moderate quantities. Excesses in eating or drinking, as well as strong spices, should be avoided. Bodily exercise is very beneficial for those who follow sedentary callings. A certain amount of caution should, however, be observed as to the form of exercise selected. Curative gymnastics are useful, and attention to regular movements of the bowels imperative. Women should lay especial stress upon a rational mode of dressing, and should avoid the wearing of tight corsets.
It needs hardly be mentioned that it is necessary to secure the advice of a physician, especially in an attack of colic. Until the physician arrives, attempts may be made to alleviate the pain by applying hot compresses to the painful parts of the abdomen, by drinking hot water, milk, or tea, and by administering a hot bath (104° F., or over). In many cases, however, cold applications are borne better than warm ; and under such circumstances an ice-bag may be applied to the region of the liver.
A course of treatment at some medicinal spa is often beneficial for the prevention of recurrences. Among European resorts may be mentioned Carlsbad, Neuenahr, and Vichy ; among American, Virginia Hot Springs, Alma Springs, Mt. Clemens, etc. Those whose means do not permit them to visit any of these resorts, may take a " Carlsbad Cure " at home. Internal medication rarely relieves severe cases of gall-stones. Surgical aid must be sought, and it is a fact that hundreds of patients have been saved by operative measures. But a successful issue may not be expected if the surgical treatment has been too long delayed.