The Treatment of skin diseases

advisable to thoroughly currette the sloughing mass and to pack the cavity with
antiseptic gauze. This operation usually relieves the throbbing pain at once,
and often reduces a high temperature to a normal degree. As the disease some-
times extends in spite of free incision, a repetition of the operation may
become necessary. A more radical treatment advocated by some surgeons is
the complete excision of the carbuncle, and may be justified in those cases in
which septicaemia develops at an early stage. 

The hypodermic injection of carbolic acid into the centre and around the
border of a carbuncle has been highly recommended and proven of great service
in checking the spread of the infiltration. The use of a small quantity of the
pure acid is much preferable to the injection of a larger quantity of a five or ten
per cent, solution, as the curative effect of the former is much more pronounced,
and it is much less liable to be absorbed and thereby produce symptoms of
carbolic poisoning. 

In mild cases a good result is usually obtained by the free application of
any antiseptic ointment, without resort to surgical measures. Indeed, the
routine treatment of carbuncle by crucial incision was condemned years ago by
as eminent a surgeon as Sir James Paget. He advocated the application of a
lead plaster with a central hole for the discharge of pus, hot fomentations, and
washing out of the cavities with a weak solution of permanganate of potash. 

The internal use of calx sulphurata has been highly recommended as a
remedy capable of lessening the pus formation, but it is certainly unreliable, if
not quite useless. 

Antipyretics may be called for during the acute stage, and alcoholic stimu-
lants are sometimes of advantage in case of extreme debility during convales-
cence, but simple nourishing food and careful nursing are usually all that is
required in the shape of general treatment.
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