#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 stellate appearance.

#Acute Abscesses of the Skin and Subcutaneous Tissue in Young Children.#—­In young infants, abscesses are not infrequently met with scattered over the trunk and limbs, and are probably the result of infection of the sebaceous glands from dirty underclothing.  The abscesses should be opened, and the further spread of infection prevented by cleansing of the skin and by the use of clean under-linen.  Similar abscesses are met with on the scalp in association with eczema, impetigo, and pediculosis.

#Veldt Sore.#—­This sore usually originates in an abrasion of the epidermis, such as a sun blister, the bite of an insect, or a scratch.  A pustule forms and bursts, and a brownish-yellow scab forms over it.  When this is removed, an ulcer is left which has little tendency to heal.  These sores are most common about the hands, arms, neck, and feet, and are most apt to occur in those who have had no opportunities of washing, and who have lived for a long time on tinned foods.