Definition And Description

A furuncle, or "boil,** is a small or moderately sized, red and painful inflammatory elevation of the skin. Its first appearance is usually heralded by a sharp stinging sensation followed by pruritus. A papule then appears and gradually increases in size and becomes hard and painful. In a day or two a whitish point appears at the apex. This small collection of pus enlarges until nearly the whole tumor becomes purulent, constituting a small abscess. Later, this little abscess bursts and discharges its pus, and, in addition, a firm cylindrical, whitish substance, commonly termed the "core." Reparative action then commences, and recovery takes place, with a depressed scar varying with the size of the boil. Furuncles may occur singly, or successively, or in crops of three or four at a time, and a succession of crops keep up the trouble for several months or longer.

The diagnosis and prognosis of Furuncle are familiar to all.

Etiology

Boils were formerly regarded as evidences of excessive good health, or as the results of high living and overfeeding, and a crop of them was looked on as a good sign, and they were even spoken of as "healthy" to have. This view is now quite abandoned, and furuncles are more generally regarded as evidence of depraved nutrition; their ex-citing cause, however, is unknown.

Treatment - The indications for treatment are to relieve the existing furuncle and to prevent the occurrence of others. If a furuncle be seen at the very commencement - that is, while it exists simply as a papule, before the formation of pus - it may be often aborted. This may be accomplished by touching it with a white-hot needle, or sharp point of a Paquelin cautery. Instead of the actual cautery, nitrate of silver may be applied. The part should be first washed clean, to remove grease, etc., from the surface, after which the solid stick should be thoroughly applied. This treatment, when adopted sufficiently early, usually prevents the further development of the furuncle. If pus has already formed, the boil should be allowed to go on to maturity without surgical interference. A little belladonna or stramonium ointment may be applied to ease the pain, and a warm poultice to hasten maturation. When fully "ripe," if it has not already opened, it may be incised and the contents evacuated. It should then, if possible, be dipped in water as hot as can be borne for ten or fifteen minutes, then dried and the cavity filled with a little pellet of absorbent cotton or marine lint, over which should be placed a piece of sheet lint smeared with a little simple cerate or, better, perhaps, equal parts of stramonium and resin ointments. The boil should not be poulticed after opening. It has often been noticed, when a boil is freely poulticed after opening, that a number of fresh ones appear in the vicinity. I presume that this is due to a little of the pus gaining entrance to the sudoriparous or sebaceous follicles and, by its irritant properties, exciting furuncular inflammation. A furuncle should never be opened prematurely. The core or slough remains attached by its deeper extremity for some time, and, until this is loosened and discharged the boil will not heal. If prematurely opened the pus is discharged, but the core remains attached much longer than if the furuncle were permitted to fully mature.

The constitutional treatment will involve the use of remedies called for by any manifest impairment of health, and particularly iron, quinine, and the mineral acids. The prophylactic or, as it might be called, the specific treatment, intended to break up and remove the tendency to furuncular inflammation, calls for the employment of a different class of drugs.

Among these the sulphite of sodium, in twenty-grain doses two or three times a day, has been highly recommended. Personally, I have used to advantage the "syrup of the hypophosphites" in dessertspoonful doses three times daily. Just at present the drug most in vogue is the Sulphide of Calcium, borrowed from the homoeopaths by Ringer, and greatly popularized through his writings. There is no doubt, however, as to its efficacy. It should be given in 1/10 grain doses four or five times a day.

Besides the drugs mentioned, the following may be considered: Acidum Carbolicum, 6; Acidum Sulphuricum, 11; Arsenic, 25; Fermentum, 53; Hydrastis, 68; Pix Liquida, 88; and Sulphur, 109.