Lappa maj.-Boils on the face, eyelids and all over.
Ledum.-Boils on the forehead, itching, pricking tearing pains worse in the evening before midnight. After mosquito stings. In drunkards.
Lycopod.-Boils on the nates; periodical boils; aggravated by warm wet poultices; after excessive wine drinking.
Manganum.-Small boils; every injury tends to suppurate.
Magnesia mur.-Boils on the nose which suppurate in one day; boils on the false ribs; menstrual derangements; diarrhoea in children.
Mercurius sol.-Boils on the ankles; coldness of the hands and feet; foetid ulcers on the legs, with gnawing itching; shooting tensive pains, worse at night; especially when complicated with bilious or mucous diarrhoea.
Natrum carb.-Boils behind the ears; ulcers on the limbs; burning in the feet when walking; sour eructations.
Nitric acid.-Numerous large boils on the scapulae, nape of the neck, nates, thighs and legs; tensive pains worse in the evening and at night; aggravated by drinking milk.
Nitrum.-Boils on the thumb.
Nux juglans.-Boils on the right arm; indurated boils; blood boils; violent itching and burning.
Nux vomica-Boils on the knees; gastric derangement; constipation.
Phosphorus acid.-Boils in the axillae, and on the nates; burning stinging pain; skin feels sore all over. In young people who grow rapidly.
Phytolacca.-Boils on the back.
Rhus rad.-Boils on the face which do not mature; blind boils.
Silicea.-Boils on the posterior portion of the thighs, and on the calves; disposition to boils; constipation.
Stramon.-Boils on the feet; coldness of the limbs in children.
Sulphur.-Boils in the ear; stinging itching with smarting after scratching; after suppressed menstruation; disposition to boils.
Zincum ox.-Boils on the abdomen, aggravated by use of wine; worse before and during menstruation.
Hordeolum, or Stye,
Is a small boil seated at the edge of the eyelids and involving a Meibomian gland. It is not an active kind of boil, but progresses sluggishly, the pustule centre being small. It is painful, and some time lapses before all traces of its existence go. There may be one, two, or more on one or both eyelids. Some persons are subject to repeated outbreaks of this furuncular inflammation. We find it most frequently in youthful individuals of rather delicate health with a tendency to acne, or in persons addicted to free living or dissipation. If by frequent relapses it induces inflammatory changes in the Meibomian glands, and is followed by fatty or chalky degeneration of their contents, it is called Chalazion.
Indications for the internal remedies are:
Graphites.-Frequent recurrence of styes, ulcerations of the margins of the lids; biting lachrymation.
Lycopod.-Styes on lids near internal canthus.
Pulsatilla.-More in affections of lower lids, conjunctiva injected, agglutination of lids in the morning; much swelling of lids; burning, drawing pain, worse evenings, in warm room, and in a cold draft, better in fresh air; catarrhal states tending to suppuration.
Staphisagria.-Affection of both lids, especially the upper ones; consequences of nervous exhaustion, the affection does not spread to the surrounding tissues; shooting, lancinating pains or tearing, mostly in paroxysms, worse during night; new ones form continually and leave small hard nodules at the tarsal edge.
Anthrax, or carbuncle,
Is a multiple furuncle. It arises as a hot, hard swelling, not so conical as that of the boil-more indurated, however, the cellular tissue around being much more extensively indurated; its color is dusky, the sensation burning, dull, throbbing; the carbuncle varies in size, the swelling becomes “brawny,” from the meshes of the cellular tissue becoming filled with a plastic lymph. The next step is the formation of a quasi-abscess; the central 16. Part of the swelling softens, and feels boggy; the skin becomes thin over the surface, and at several points openings occur, through which slowly issues more or less sanious pus; and a the little holes are seen to be plugged up by small white cores, which presently loosen and come away; the apertures are red and papillated, the edges indurated and everted, particularly when several openings coalesce, so as to form one or more large openings. Gangrene may set in. The healing process is often indolent, the parts remaining undermined, brawny, dusky, shreddy, and also sloughy. Carbuncles are generally solitary. The patient, if the attack be severe, gets into a very depressed state. The posterior aspect of elderly people is the selective seat of carbuncle.
In carbuncles there are similar changes to those in boils, but a much severer degree of disease. Here a group of sebaceous glands is involved, and in consequence of the more cachectic state of the nutrition the reparative attempt is less perfect, the inflammation is of a lower type, and the cellular tissue and dies to a much greater extent. The nutrition is not only unequal to prevent the local disorder, but also incapable of putting repair in proper operation; and there is one disposition in carbuncular subjects that perhaps has a peculiar influence in disposing to sloughing and gangrene of the cellular tissue; this is the tendency to, or an actual, diabetic habit. Sugar occurs in the pus of the carbuncle, and it is a curious fact that when anthrax develop the sugar is diminished or disappears from the urine.
In summer up the conditions under which boils occur, it will not be difficult to classify the main ones as follows: I. during seasonal changes in spring and summer; 2. from eating diseased meat (frozen); 3. when any special alteration is made in the ordinary habits and economy of the body, as in the training of prize-fighters; 4. from the influence of cadaveric poisons; 5. from sudden change of diet’ 6. after fatigue of long duration; 7. during convalescence from debilitating diseases; 8. as a consequence of the action of septic poisons, as in fevers, etc.; 9. in albuminuria; 10. in the diabetic habit; 11. during adolescence, and in the first stage of manhood. In most of these cases there are “debility” and an over-loaded state of system-for example, the circulation of urea, of sugar, of septic poison, or of effete matter which is plentiful during convalescence; and it only needs the action of some local irritant to determine the development of furunculi in the parts to which that irritant is applied.
Diagnosis of Boils and Carbuncles.-No error can possibly be made in respect to these two diseases; in the former the hard, deeply-seated induration, the pain, the central suppuration, and the “core,” are distinctive. The manifold openings, the boggy feel, the sloughing, the grumous discharge, and the implication of the cellular tissue in carbuncle are very peculiar. Furunculi are sometimes epidemic.
Treatment.-I would add one word of caution in regard to the use of poultices: The poultices should be confined as much as possible to the exact seat of local inflammation. Nothing is more common than the springing up of fresh around old boils from the neglect of this precaution. The same local measures as recommended in furuncles are useful here. In addition consider the following:
The early application of ice and salt bags to the swelling is said to lessen the extent of the disease. If the sloughing is extensive charcoal and yeast poultices may be used. The sloughs should be picked out as fast as they loosen, and the ulcer washed out once or twice a day with a weak solution of carbolic acid, peroxide of hydrogen.
Dr. Owen, of LOndon, treats large carbuncles with extensive sloughs by removing the sloughs, under an anaesthetic, scraping the sores and the diseased undermined skin with Volkmann`s spoon and trimming off the ragged edges. The wounds are then washed with a I-1000 sublimate solution, dusted with iodoform, and covered with moist perchloride gauze and blue wool. Do not use the knife to open a carbuncle.
The indications for internal remedies are as follows:
Aconite.-As an occasional remedy, when there is much inflammation with high fever.
Anthracinum.-When the burning pain is violent and not relieved by Arsenicum; cerebral or typhoid symptoms; evidences of blood poisoning; sloughing, abundant discharge of ichorous, terribly smelling pus.
Apis.-Continued extension of the erysipelatoid inflammation with stinging burning.
Arctium lappa.-Has great reputation; used both internally and locally.
Arsen. alb.-Large, painful and malignant carbuncles;great prostration; great restlessness; great thirst, drinking but little at a time; all the symptoms are worse in the night, and better from external warm applications.
Bellad.-Bright redness, with throbbing pain; when cerebral complications arise; erysipelatous inflammation around the carbuncle; drowsiness with inability to go to sleep.
Bufo, at the commencement very efficient.
Carbo-veg.-Dark blackish appearance of the sore; fetid odor of the discharge; hippocratic face; blood poisoning.
Cinchona.-When the asthenic character of the disease is well marked; debility from excessive suppuration.
