A couple of weeks ago I posted an article on erysipelas, an infection of the skin similar to cellulitis. I then got to thinking about boils and carbuncles. I thought I’d already written about abscesses (of which boils and carbuncles are a type[1]), but apparently I hadn’t yet covered them. These are common infections we all need to learn about because receiving licensed medical care is becoming increasingly uncommon. I’ve been told my own local hospital is now “code purple”—no elective surgeries and patients are being turned away. Heaven help the guy with a broken leg or appendicitis. A friend and her husband run a walk-in clinic. Two weeks ago their office was full at 10AM—all for covid patients of one flavor or another (most having to get tested so they could return to work/school)—and so they couldn’t take any more patients for the rest of the day. I haven’t heard from her since; I’m sure they’re still swamped.
As nurses, doctors, and others in the medical profession refuse to take the jab and quit their jobs, competent medical care will become even rarer, at least for a while. We’ve got to be prepared to take matters into our own hands, especially for the more minor issues. At the very least, we’ll need to have our own supplies.
The following information comes directly from The Ship’s Medicine Chest and Medical Aid at Sea, a government publication.
Boils (Furuncles) and Carbuncles
Whereas folliculitis (see p. 238) resembles small pimples around hair follicles, boils and carbuncles show deeper and more severe skin involvement. A furuncle or boil is a localized, painful, red swelling of skin and deeper tissue around one follicle. As the lesion progresses, it tends to point at the surface and discharge pus when heat is applied in the form of hot compresses. A carbuncle is a similar process involving several hair follicles with several draining points. Both furuncles and carbuncles are painful and may be accompanied by tender swollen glands near the site of infection. Fever, chills, and other signs of serious generalized infection will be present if septicemia (blood poisoning) is a complication. The degree of generalized involvement with serious symptoms depends on the affected individual’s ability to fight the infection.
As with any inflammation, white blood cells accumulate in the infected area and ingest the bacteria. Sometimes the white cells kill off the bacteria early in the development of a pimple or boil and the inflammation subsides without coming to a head. If the white cells are somewhat less successful, a wall of successfully-resisting body cells is built up around the boil. The tissue in the center of the boil then breaks down, and together with the bacteria and white blood cells form the yellowish-white center or core of the boil. This dead matter may be absorbed if the pimple or boil is small or it may break through the skin and discharge itself. Boils at this early stage never should be squeezed or drained as this may interfere with the body’s ability to resist the infection and cause bacteria to enter the bloodstream. The boil may be opened by the attendant only after it comes to a head.
Treatment
The same treatment applies to both boils and carbuncles although the latter are considered more serious infections. Initially, when the lesion appears as a red hard swelling, hot water compresses made from clean white washcloths or torn white sheets should be applied to the involved skin areas for 15 minutes. Hot saline solution (two level teaspoonfuls of table salt to 1000 ml of water) can be used for the compresses. The temperature of the compresses should be not be so hot that they burn the patient’s skin. If the compresses cannot be handled comfortably by the attendant, then they are too hot for the patient. Bacitracin ointment should be applied to the lesions following the compresses.
When the boil comes to a head with a white spot at the center, it may be incised and drained. First the skin should be cleansed with rubbing alcohol. Then, the tip of a sterile knife blade or needle should be inserted into the white center of the boil so that pus is discharged. As long as there is drainage of pus, skin lesions should be covered loosely with sterile gauze squares. Otherwise the lesions may be left open to the air.
Folliculitis, boils, or carbuncles on or around the nose, nostrils, and on the lips should not be opened, except by a physician. There is always the danger of extension of the infection to the brain with serious consequences, even death. These lesions should be allowed to discharge spontaneously.
In addition to local therapy, treatment with systemic antibiotics should be given for boils if local treatment fails, the lesions are multiple or large, or there is associated fever. Treatment with systemic antibiotics is recommended for all cases of carbuncles; even if single these are serious infections, which are difficult to cure with topical therapy. Erythromycin 500 mg should be given by mouth four times daily for ten days. If the patient has systemic symptoms such as malaise, nausea, or fever, he should be on bed rest along with ample fluid intake. For pain, aspirin 600 mg should be given by mouth every three to four hours as needed. If aspirin is not well tolerated by the patient, acetaminophen may be tried at the same dosage and frequency.[2]
That concludes the information from The Ship’s Medicine Chest. Following is additional information from other sources.
Never press or squeeze a boil, because this can spread the infection to other parts of the body. Allow the pus to drain naturally. [3]
Risk factors for developing boils and carbuncles
- Poor hygiene
- Poor overall health
- Friction from shaving or clothing
- Diabetes
Most carbuncles are caused by the Staphylococcus aureus bacteria. As such, they are contagious and can spread to family members or others in close contact. Carbuncles are more common in men than women. They may range in size from a pea to a golf ball. While they can occur anywhere on the body, they are most common on the back and nape of the neck.[4]
If self-treatment of boils and carbuncles with hot compresses fails to resolve the condition within two weeks, professional treatment should be considered. Reasons to seek immediate attention from a physician for treatment of boils and carbuncles include:
- Fever or other systemic symptoms
- Location on the face or above the spine
- Swelling around the carbuncle or worsening pain
- Carbuncle returns frequently
[1] David Werner, Where There Is No Doctor, 1992, 420.
[2] The Ship’s Medicine Chest and Medical Aid at Sea, 1978, 235-36.
[3] David Werner, Where There Is No Doctor, 1992, 202.
[4] “Carbuncle,” Medline Plus, https://medlineplus.gov/ency/article/000825.htm (accessed 30 September 2021).
5 october 2021
I saw Boil and Carbuncle open for Hall and Oates in 1978.
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