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.

#Carbuncle# may be looked upon as an aggregation of boils, and is
characterised by a densely hard base and a brownish-red discoloration of
the skin. It is usually about the size of a crown-piece, but it may
continue to enlarge until it attains the size of a dinner-plate. The
patient is ill and feverish, and the pain may be so severe as to prevent
sleep. As time goes on several points of suppuration appear, and when
these burst there are formed a number of openings in the skin, giving it
a cribriform appearance; these openings exude pus. The different
openings ultimately fuse and the large adherent greyish-white slough is
exposed. The separation of the slough is a tedious process, and the
patient may become exhausted by pain, discharge, and toxin absorption.
When the slough is finally thrown off, a deep gap is left, which takes a
long time to heal. A large carbuncle is a grave disease, especially in a
weakly person suffering from diabetes or chronic alcoholism; we have on
several occasions seen diabetic coma supervene and the patient die
without recovering consciousness. In the majority of cases the patient
is laid aside for several months. It is most common in male adults over
forty years of age, and is usually situated on the back between the
shoulders. When it occurs on the face or anterior part of the neck it is
especially dangerous, because of the greater risk of dissemination of
the infection.

A carbuncle is to be differentiated from an ulcerated gumma and from
anthrax pustule.

[Illustration: FIG. 95.--Carbuncle of seventeen days' duration in a
woman aet. 57.]

_Treatment._--Pain is relieved by full doses of opium or codein, and
these drugs are specially indicated when sugar is present in the urine.
Vaccines may be given a trial. The diet should be liberal and easily
digested, and strychnin and other stimulants may be of service. Locally
the treatment is carried out on the same lines as for boils.

In some cases it is advisable to excise the carbuncle or to make
incisions across it in different directions, so that the resulting wound
presents a