#Boils and Carbuncles.#—­These result from infection with the staphylococcus aureus, which enters the orifices of the ducts of the skin under the influence of friction and pressure, as was demonstrated by the well-known experiment of Garre, who produced a crop of pustules and boils on his own forearm by rubbing in a culture of the staphylococcus aureus.

A #boil# results when the infection is located in a hair follicle or sebaceous gland.  A hard, painful, conical swelling develops, to which, so long as the skin retains its normal appearance, the term “blind boil” is applied.  Usually, however, the skin becomes red, and after a time breaks, giving exit to a drop or two of thick pus.  After an interval of from six to ten days a soft white slough is discharged; this is known as the “core,” and consists of the necrosed hair follicle or sebaceous gland.  After the separation of the core the boil heals rapidly, leaving a small depressed scar.

Boils are most frequently met with on the back of the neck and the buttocks, and on other parts where the skin is coarse and thick and is exposed to friction and pressure.  The occurrence of a number or a succession of boils is due to spread of the infection, the cocci from the original boil obtaining access to adjacent hair follicles.  The spread of boils may be unwittingly promoted by the use of a domestic poultice or the wearing of infected underclothing.

While boils are frequently met with in debilitated persons, and particularly in those suffering from diabetes or Bright’s disease, they also occur in those who enjoy vigorous health.  They seldom prove dangerous to life except in diabetic subjects, but when they occur on the face there is a risk of lymphatic and of general pyogenic infection.  Boils may be differentiated from syphilitic lesions of the skin by their acute onset and progress, and by the absence of other evidence of syphilis; and from the malignant or anthrax pustule by the absence of the central black eschar and of the circumstances which attend upon anthrax infection.

Treatment.—­The skin of the affected area should be painted with iodine, and a Klapp’s suction bell applied thrice daily.  If pus forms, the skin is frozen with ethyl-chloride and a small incision made, after which the application of the suction bell is persevered with.  The further treatment consists in the use of diluted boracic or resin ointment.  In multiple boils on the trunk and limbs, lysol or boracic baths are of service; the underclothing should be frequently changed, and that which is discarded must be disinfected.  In patients with recurrence of boils about the neck, re-infection frequently takes place from the scalp, to which therefore treatment should be directed.

Any impaired condition of health should be corrected; when, there is sugar or albumen in the urine the conditions on which these depend must receive appropriate treatment.  When there are successive crops of boils, recourse should be had to vaccines.  In refractory cases benefit has followed the subcutaneous injection of lipoid solution containing tin.