BOILS AND CARBUNCLES: THEIR TREATMENT BY X-RAYS
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Boils and Carbuncles: Their Treatment by X-RaysBOILS AND CARBUNCLES: THEIR
Roentgen Clinic, Allahabad
These frequent and unwelcome visitors are
always due to an infection. The greatest pre- ventative is constant cleanliness. The back of the neck is the most frequent place, in men, for boils and carbuncles to occur, as in this situa- tion the skin is coarse and ill-nourished and in some cases abrasions caused by a stiff collar
encourage invasion by micro-organisms. Dia- betes particularly predisposes to boils and car- buncles. Carbuncles are more frequent in old than in young men; they develop more often on the back of the neck than on any other part of the body.
Carbuncles and boils on the cheeks, upper
lip and nose are particularly dangerous, owing to the risk of cavernous sinus thrombosis via the facial and ophthalmic veins, or the deep facial vein and the pterygoid plexus.
It is practically impossible in the beginning tn determine in most instances that a patient has a carbuncle. An apparent boil may develop into several boils, with several openings, and become a carbuncle. The patient complains of tenderness and stiffness at the site of origin of the carbuncle. The subcutaneous tissues be- come painful and indurated, and the overlying skin is red. Gradual extension occurs and
after ft few days areas of softening appear.
The skin then gives way and thick pus and
sloughs discharge. The condition sometimes extends widely, and fresh openings appear in the skin, and tend to coalesce with those pre- viously formed.
Treatment
Treatment consists, in the first place, in local cleanliness, improving the general resistance of the patient by means of tonics, fresh air, ultra-violet rays and vaccines.
Pusey and Ormsby consider x-ray therapy a
very valuable method of treatment in recurrent furunculosis in circumscribed areas. Roentgen therapy gives such excellent results in carbun- cles and boils that in my opinion it should be the treatment of choice, particularly in those which are considered bad surgical risks. The beneficial effect of irradiation on lesions of this character?furuncle, carbuncle, cellulitis, phleg- mon or abscess of soft tissues?especially when treated early, before the stage of suppuration, has been demonstrated by many workers. It is surprising that the value of such a simple and
effective treatment is not generally realized by the profession. The rapidity of improvement, the relief of
pain and the abortion of the development and regression of the inflammatory process are all so striking and spectacular by x-ray treatment that they have to be seen to be believed.
Prompt and marked benefit is derived in most cases. Pain is relieved in about 24 hours, but in a small percentage of cases this relief may be preceded by a temporary increase
Fig. 1. Fig. 1. Fig. 2. Fig. 2.
Feb., 1942] BOILS AND CARBUNCLES : GHOSH 83
in the pain. The treatment is most effective during the early stages when other methods of treatment are least effective; it is painless and Jnexpensive and does not interfere with a
Patient's activities; it often relieves pain in a few hours, makes hot or other dressings unnecessary, or shortens the period during which they must be applied; it often obviates an operation; and it yields a better cosmetic result. The dose of .T-ray should preferably be small,
and usually a single exposure is sufficient. In cases which do not react promptly to the initial exposure, the treatment may have to be repeated at intervals, depending on the dose, which may vary between 25 and 75 per cent of an erythema skin dose. The quality of the rays should be graded according to the depth and thickness of the lesion. With such doses there should not he any skin or general systemic reaction; therefore, the treatment may be given to weak and febrile patients without danger. Irradiation
uring the suppurative stage is less effective, ut even then it may relieve pain and may
v'orten the course of the inflammatory process. ~arbuncles treated in the early stages will aPidly localize, cease to extend and readily Permit surgical drainage.
Technique } have collected here some of the techniques opted by various authorities and the results
chieved by them, in treating boils and carbuncles.
In single boils and carbuncles MacKee and Niles claim to have obtained good results with
v a single dose of 230 r of x-rays filtered with 3 mm. of aluminium. Goyle has obtained re-
markable results by the use of intensive filtered radiations in carbuncles. Dunham obtained
prompt cures in 11 cases of carbuncles with the same technique. Ruggles confirms Dunham's
work, obtaining quick cures in both boils and carbuncles. Dunham has obtained excellent results with similar treatment in cases of strep- tococcal palmar abscess. Leddy and Morton state that when a lesion
is in the indurated stage before suppuration has set in, x-rays cause rapid regression in about
50 per cent of the cases and considerable relief in the remainder. They had 74 cases of boils
and 26 cases of carbuncles. They found that
boils responded much better and more rapidly than carbuncles. They used 135 kv., 4 mm.
al. filter 16-inch distance, 5 ma. for 10 minutes for boils and the same factors for 15 to 18 minutes for carbuncles. They found that irra- diation of affected areas prevents the infection of other follicles. Desjardins believes that
radiotherapy may render surgery unnecessary and that small doses (10 to 15 per cent erythema dose) give the best results. Baensch treated 103 cases of furuncle of the
face with x-rays and the same number of cases with other measures. The mortality in the irradiated cases was 1.9 per cent and in the others 10.7 per cent. In a few hours after
treatment, the pain stopped and the tempera- ture fell. The time required for treatment was shortened and there were no recurrences in the treated area. His dosage was 150 to 250 r
filtered with 0.5 mm. zinc and 3 to 5 mm. of
aluminium at 30 cm. focal distance. Firor reported on 56 carbuncles treated with
x-rays, in only one of which was .excision
required. He found that smaller doses were
just as successful as large. Hodges believes that in furuncles filtered
x-rays give better results than small doses of
unfiltered, low-voltaee x-rays. He uses doses of 125 r at 125 kv. filtered with 4 to 6 mm. of aluminium at 10 inches distance for several
weekly treatments and with this method causes disappearance of existing furuncles and almost always aborts newly-forming ones. With carbuncles, on the other hand, he considers that small doses (100 r at 85 kv.) of unfiltered
rays for two or three treatments give the best results. Irradiation limits the spread of the lesion, lessens pain, increases drainage, shortens the course and lowers the mortality. Meyer reports on 50 cases of furunculo'is of
the lip, which were treated with x-rays, without a failure or mishap. A single dose of 100 to 200 r at 100 kv. was applied through a 1 to
5 mm. of aluminium filter and Occasionally a
second dose was given on the third day. I have recorded here a series of 20 cases of
carbuncles and boils treated by me during the
Fig. 3.
Fig. 3.
84 THE INDIAN MEDICAL GAZETTE [Feb., 1942
Table
Record of cases of boils and carbuncles treated by x-rays at the Roentgen Clinic, Allahabad, during the last years
Regis- ter Name Age num-
ber
Sex Clinical history and findings
M. Painful swelling of the whole of the right hand and wrist and high fever (103?-104?). Two weeks ago had a prick with a bamboo chip.
F. Painful hard swell- ing on the lateral aspect of both the arms and high fever?duration 2 weeks.
M. A big painful hard swelling in the right gluteal region and high fever. Size of the swell- ing about 8 inches in diameter. Duration?10 days. Diabetes?years
M. A big swelling on the back near the neck with several small openings and fever 10 days. Diabetic.
M.
M.
M.
A big painful hard swelling on the chest in the right subclavicular region and high fever?one week.
A swelling about 1 inch in diameter on the nape of the neck with several small openings.
A big painful hard swelling (about 6 inches in diameter) on the back near the neck with innumer able small openings. Fever present (sent by Capt. R. C. B.).
Diagnosis
Cellulitis
Abscess
A big abscess or an early case of carbuncle with diabetes.
Carbuncle with diabetes.
Details of x-ray treatment
Filters?1.0 mm. Al. Current?4 ma. at 100 kv. Distance?30 cm. Dose?250 r.
Factors the same as above. Dose?100 r to each area. ?
Filters?0.3 cu. 4 1.0 Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?150 r.
Filters?4 mm. Al. Current?4 ma. at 150 kv. Distance?30 cm. Dose?200 r.
Filters?0.5 cu. 4- 1.0 Al. Current?4 ma. at 180 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?175 r.
Filters?4 mm. Al. Current?4 ma. at 150 kv. Distance?30 cm. Dose?200 r.
Filters?0.5 cu. 4- 1.0 Al. Current?4 ma. at 180 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?200 r.
Dates on which the treatments were given
5-10-38 and 8-10-38.
1
Results
Pain siibsided after the first sitting. Fever and swelling gradually went down.
Complete regres- sion in 10 days.
The pain was less after the first sitting. The inflammation subsided com- pletely in about 2 weeks.
Healed in 2 weeks.
The swelling subsided in about 2 weeks.
The lesion healed up in a week.
The pain sub- sided after the first dose, the swelling gradually shrivelled up and became softer. A week later the attending doctor made a small opening to allow drainage of the pus. The patient made an uneventful recovery.
Feb., 1942] BOILS AND CARBUNCLES : GHOSH 85
Table?contd.
"308 M.K. ! 55
494 K.L. 16
M. A red angry- looking swelling on the right shoulder. Size 2 inches in diameter. In the centre shows several minute openings. Fever present. No sugar in "urine.
M. A huge red swell- ing on the back with numerous openings. Duration? 2 weeks. Fever present.
A huge red swelling on the back with many small openings? 13 days, high fever. Urine?free from sugar. A painful swell- ing of the left middle finger and hand-?discharging pus. Duration? 6 weeks. He was operated twice and is a
diabetic (sent by Dr. Ajmal Khan).
A painful swelling near the anus? 2 months.
M
M.
M.
M.
M.
A big red swelling on the right temporal region with many small openings in the centre. Size 4" X 3"? 11 days. Sugar in urine.
A painful swelling of the palm of the left hand with fever?12 days.
A big painful swelling in the right gluteal region ?1 week. High fever.
Diagnosis Details of z-ray
treatment
Carbuncle
Do.
Do.
Cellulitis and osteo- myelitis (the latter condition was verified by x-ray examina- tion).
Abscess (ischio- rectal).
Abscess
Filters?4 mm. Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?small. Dose?200 r.
Filters?0.5 cu. -f- 1 mm. Al. Current?4 ma. at 180 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?200 r.
Filters?0.5 cu. + 1 mm. Al. Current?4 ma. at 180 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?175 r.
Filter?0.3 cu. -f 1 mm. Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?125 r weekly
Filter?0.3 cu. + 1.0 Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?125 r weekly.
Factors as above. Dose?150 r.
Dates on which the treatments were given
Total number
20-4-40
17-6-40 and 19-6-40.
18-6-40
Results
The pain was' relieved after the first sitting. The swelling gradually sub- sided and the wound healed up in about 2 weeks.
The swelling gradually sub- sided and the whole thing healed up in about 6 weeks.
Healed up in 6 weeks.
Made a com- plete recovery without any further surgical aid.
The swelling subsided com- pletely and has not recurred since.
Made an uneventful recovery.
Swelling and pain subsided completely.
The pain was much less after the irradiation and the abscess burst 2 days after.
86 THE INDIAN MEDICAL GAZETTE [Feb., 1942
Table?concld.
ber
741 R.B. 50 M.
812 B. 39 M.
832 H.S. 50 M.
836 S.N.G. 35 M.
Clinical history and findings
A very painful red swelling on the tip of the nose and high fever.
Painful swelling in the right axillary region.
Painful swelling in the region of the left parotid and fever?1 week.
A painful swelling in the left leg with several
_
A painful swelling on the tip of the nose.
Diagnosis
Boil
Abscess
Do.
Carbuncle
Boil
Details of x-ray treatment
Filter?1 mm. Al. Current?4 ma. at 100 kv. Distance?30 cm. Portal?small. Dose?150 r.
Filters?2 mm. Al. Current?4 ma. at 120 kv. Portal?8 X 10 cm. Dose?200 r.
Filters?0.3 cu. + 1 Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?150 r.
Factors and dosage as above.
Filters?1 mm. Al. Current?4 ma. at 100 kv. Distance?30 cm. Portal?small. Dose?125 r.
Dates on which the treatments were given
6-9-40
14-10-40
Results
Marked relief and complete regression.
Relief in pain. The abscess was subsequently opened for draining pus.
Subsided completely.
Subsided gradually.
last two and a half years, by ?-rays. I admit
that the number is too small to make any
sweeping statement about the success of this
treatment, but I was struck with the rapidity of improvement, the relief of pain, and the
regression of the inflammatory process in these cases. The cosmetic result was extremely good and the healing was quicker than could be ex- pected by any other means, including surgery. The accompanying photographs show the re-
sult of rr-ray treatment in one of my cases of carbuncle recorded here. I am convinced that with rr-ray treatment the
involution occurs more quickly, the amount of necrosis is decreased, liquefaction takes place more rapidly and is less extensive, and the course of the disease is greatly decreased and at times aborted entirely, when treatment is
given sufficiently early. Mode of action of x-rays in such inflam-
matory conditions.?Various explanations have been advanced to account for the favourable influence of arrays on inflammatory conditions and the multiplicity of such explanations prob- ably has led many physicians to discredit the
clinical evidence or to ascribe it to over-
enthusiasm of the axray therapist. Indeed, without a satisfactory and convincing explana- tion it would be difficult to believe that the same
agent can be therapeutically effective against so many different forms of inflammation in different organs or parts of the body. And yet the reason appears to be quite simple and to
rest on sound and abundant experimental facts. For radiation to act in much the same way, and at the same time on so many forms of acute
inflammation, the lesions must have some com- mon factor. Now, what may this factor be? The exceptional radio-sensitiveness of certain
leucocytes, notably the lymphocytes, has been demonstrated and established by the early experiments of Heineke and has since been fully confirmed by many others. All the clinical circumstances indicate that inflammatory lesions respond to irradiation in proportion to the degree of leucocytic infiltration, and that the rays act primarily by destroying the infiltrating cells. In favour of this view are the experimentally proved sensitiveness of lymphocytes on the one hand, and on the other hand the fact that the
Feb., 1942] SULFANILAMIDE IN ASCITES : JEEVANADAM & OTHERS 87
rate of regression of acute inflammatory pro- cesses corresponds to the rate at which lympho- cytes are known to be destroyed by Eradiation. The rapidity with which the symptoms often
abate and the physical signs disappear after exposure to a small or a moderate dose of x-rays Indicate that the destruction of lymphocytes is he primary and direct result of irradiation, the lymphocytes are the only cells in the body, e^cept the basal epithelium of the salivary ?Jands, which react to irradiation in such a short 1I;ne and at such a rate. Also variation in the degrees of leucocytic infiltration in different Patients may explain the partial or complete ailure of irradiation in some cases. If it can e assumed that the leucocytes which the
0lganism mobilizes around the site of infection
^present an effort to localize the infection and o dispose of the infectious material, it must also e assumed that the infiltrating cells contain or
elaborate within themselves the protective sub- dances which enable them to destroy or neutral- lz.e the bacterial or other toxic products which give rise to the inflammation. If these assump- i?ns are well founded it seems reasonable to
? e^uce that irradiation, by destroying the
nhltrating leucocytes, causes the protective ^stances contained by such cells to be derated and to be made even more readily available for defensive purposes than they were n the intact cells.
Conclusion.?'The evidence of the therapeutic value of x-ray treatment in acute inflammatory c?nditions like boils and carbuncles is so
abundant and so generally favourable that one bonders why this method of treatment is not ttiore widely, used. Perhaps the very multi- Phcity 0f inflammatory lesions in which x-ray , erapy has been claimed to be effective has leu
not unnatural scepticism; or failure to utilize *}e treatment may be due to an excessive fear
ot ill-effects?a fear probably springing from rePorts of x-ray injuries incurred during treat-
ment of malignant tumours with very large aoses of x-rays, or from systemic reactions which go often follow irradiation for conditions
requiring prolonged exposures. But in view of Ule short exposure and small doses required for acute inflammatory lesions, such as those
j^entioned in this paper, such fears have no
BIBLIOGRAPHY
Kaplan, I. I. (1937) .. Radiation Therapy. Oxford University Press, London.
A(?Kee, G. M. (1938). X-Rays and Radium in the Treatment of Diseases of the Skin. Henry Kimpton,
, London.
?j?cK, H. E., Pemberton, Principles and Practice of ^d Coulter, J. S. Physical Therapy, 3. W. F.
p y<**). Prior Co., Haggerstown.
Roentgen Clinic, Allahabad
These frequent and unwelcome visitors are
always due to an infection. The greatest pre- ventative is constant cleanliness. The back of the neck is the most frequent place, in men, for boils and carbuncles to occur, as in this situa- tion the skin is coarse and ill-nourished and in some cases abrasions caused by a stiff collar
encourage invasion by micro-organisms. Dia- betes particularly predisposes to boils and car- buncles. Carbuncles are more frequent in old than in young men; they develop more often on the back of the neck than on any other part of the body.
Carbuncles and boils on the cheeks, upper
lip and nose are particularly dangerous, owing to the risk of cavernous sinus thrombosis via the facial and ophthalmic veins, or the deep facial vein and the pterygoid plexus.
It is practically impossible in the beginning tn determine in most instances that a patient has a carbuncle. An apparent boil may develop into several boils, with several openings, and become a carbuncle. The patient complains of tenderness and stiffness at the site of origin of the carbuncle. The subcutaneous tissues be- come painful and indurated, and the overlying skin is red. Gradual extension occurs and
after ft few days areas of softening appear.
The skin then gives way and thick pus and
sloughs discharge. The condition sometimes extends widely, and fresh openings appear in the skin, and tend to coalesce with those pre- viously formed.
Treatment
Treatment consists, in the first place, in local cleanliness, improving the general resistance of the patient by means of tonics, fresh air, ultra-violet rays and vaccines.
Pusey and Ormsby consider x-ray therapy a
very valuable method of treatment in recurrent furunculosis in circumscribed areas. Roentgen therapy gives such excellent results in carbun- cles and boils that in my opinion it should be the treatment of choice, particularly in those which are considered bad surgical risks. The beneficial effect of irradiation on lesions of this character?furuncle, carbuncle, cellulitis, phleg- mon or abscess of soft tissues?especially when treated early, before the stage of suppuration, has been demonstrated by many workers. It is surprising that the value of such a simple and
effective treatment is not generally realized by the profession. The rapidity of improvement, the relief of
pain and the abortion of the development and regression of the inflammatory process are all so striking and spectacular by x-ray treatment that they have to be seen to be believed.
Prompt and marked benefit is derived in most cases. Pain is relieved in about 24 hours, but in a small percentage of cases this relief may be preceded by a temporary increase
Fig. 1. Fig. 1. Fig. 2. Fig. 2.
Feb., 1942] BOILS AND CARBUNCLES : GHOSH 83
in the pain. The treatment is most effective during the early stages when other methods of treatment are least effective; it is painless and Jnexpensive and does not interfere with a
Patient's activities; it often relieves pain in a few hours, makes hot or other dressings unnecessary, or shortens the period during which they must be applied; it often obviates an operation; and it yields a better cosmetic result. The dose of .T-ray should preferably be small,
and usually a single exposure is sufficient. In cases which do not react promptly to the initial exposure, the treatment may have to be repeated at intervals, depending on the dose, which may vary between 25 and 75 per cent of an erythema skin dose. The quality of the rays should be graded according to the depth and thickness of the lesion. With such doses there should not he any skin or general systemic reaction; therefore, the treatment may be given to weak and febrile patients without danger. Irradiation
uring the suppurative stage is less effective, ut even then it may relieve pain and may
v'orten the course of the inflammatory process. ~arbuncles treated in the early stages will aPidly localize, cease to extend and readily Permit surgical drainage.
Technique } have collected here some of the techniques opted by various authorities and the results
chieved by them, in treating boils and carbuncles.
In single boils and carbuncles MacKee and Niles claim to have obtained good results with
v a single dose of 230 r of x-rays filtered with 3 mm. of aluminium. Goyle has obtained re-
markable results by the use of intensive filtered radiations in carbuncles. Dunham obtained
prompt cures in 11 cases of carbuncles with the same technique. Ruggles confirms Dunham's
work, obtaining quick cures in both boils and carbuncles. Dunham has obtained excellent results with similar treatment in cases of strep- tococcal palmar abscess. Leddy and Morton state that when a lesion
is in the indurated stage before suppuration has set in, x-rays cause rapid regression in about
50 per cent of the cases and considerable relief in the remainder. They had 74 cases of boils
and 26 cases of carbuncles. They found that
boils responded much better and more rapidly than carbuncles. They used 135 kv., 4 mm.
al. filter 16-inch distance, 5 ma. for 10 minutes for boils and the same factors for 15 to 18 minutes for carbuncles. They found that irra- diation of affected areas prevents the infection of other follicles. Desjardins believes that
radiotherapy may render surgery unnecessary and that small doses (10 to 15 per cent erythema dose) give the best results. Baensch treated 103 cases of furuncle of the
face with x-rays and the same number of cases with other measures. The mortality in the irradiated cases was 1.9 per cent and in the others 10.7 per cent. In a few hours after
treatment, the pain stopped and the tempera- ture fell. The time required for treatment was shortened and there were no recurrences in the treated area. His dosage was 150 to 250 r
filtered with 0.5 mm. zinc and 3 to 5 mm. of
aluminium at 30 cm. focal distance. Firor reported on 56 carbuncles treated with
x-rays, in only one of which was .excision
required. He found that smaller doses were
just as successful as large. Hodges believes that in furuncles filtered
x-rays give better results than small doses of
unfiltered, low-voltaee x-rays. He uses doses of 125 r at 125 kv. filtered with 4 to 6 mm. of aluminium at 10 inches distance for several
weekly treatments and with this method causes disappearance of existing furuncles and almost always aborts newly-forming ones. With carbuncles, on the other hand, he considers that small doses (100 r at 85 kv.) of unfiltered
rays for two or three treatments give the best results. Irradiation limits the spread of the lesion, lessens pain, increases drainage, shortens the course and lowers the mortality. Meyer reports on 50 cases of furunculo'is of
the lip, which were treated with x-rays, without a failure or mishap. A single dose of 100 to 200 r at 100 kv. was applied through a 1 to
5 mm. of aluminium filter and Occasionally a
second dose was given on the third day. I have recorded here a series of 20 cases of
carbuncles and boils treated by me during the
Fig. 3.
Fig. 3.
84 THE INDIAN MEDICAL GAZETTE [Feb., 1942
Table
Record of cases of boils and carbuncles treated by x-rays at the Roentgen Clinic, Allahabad, during the last years
Regis- ter Name Age num-
ber
Sex Clinical history and findings
M. Painful swelling of the whole of the right hand and wrist and high fever (103?-104?). Two weeks ago had a prick with a bamboo chip.
F. Painful hard swell- ing on the lateral aspect of both the arms and high fever?duration 2 weeks.
M. A big painful hard swelling in the right gluteal region and high fever. Size of the swell- ing about 8 inches in diameter. Duration?10 days. Diabetes?years
M. A big swelling on the back near the neck with several small openings and fever 10 days. Diabetic.
M.
M.
M.
A big painful hard swelling on the chest in the right subclavicular region and high fever?one week.
A swelling about 1 inch in diameter on the nape of the neck with several small openings.
A big painful hard swelling (about 6 inches in diameter) on the back near the neck with innumer able small openings. Fever present (sent by Capt. R. C. B.).
Diagnosis
Cellulitis
Abscess
A big abscess or an early case of carbuncle with diabetes.
Carbuncle with diabetes.
Details of x-ray treatment
Filters?1.0 mm. Al. Current?4 ma. at 100 kv. Distance?30 cm. Dose?250 r.
Factors the same as above. Dose?100 r to each area. ?
Filters?0.3 cu. 4 1.0 Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?150 r.
Filters?4 mm. Al. Current?4 ma. at 150 kv. Distance?30 cm. Dose?200 r.
Filters?0.5 cu. 4- 1.0 Al. Current?4 ma. at 180 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?175 r.
Filters?4 mm. Al. Current?4 ma. at 150 kv. Distance?30 cm. Dose?200 r.
Filters?0.5 cu. 4- 1.0 Al. Current?4 ma. at 180 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?200 r.
Dates on which the treatments were given
5-10-38 and 8-10-38.
1
Results
Pain siibsided after the first sitting. Fever and swelling gradually went down.
Complete regres- sion in 10 days.
The pain was less after the first sitting. The inflammation subsided com- pletely in about 2 weeks.
Healed in 2 weeks.
The swelling subsided in about 2 weeks.
The lesion healed up in a week.
The pain sub- sided after the first dose, the swelling gradually shrivelled up and became softer. A week later the attending doctor made a small opening to allow drainage of the pus. The patient made an uneventful recovery.
Feb., 1942] BOILS AND CARBUNCLES : GHOSH 85
Table?contd.
"308 M.K. ! 55
494 K.L. 16
M. A red angry- looking swelling on the right shoulder. Size 2 inches in diameter. In the centre shows several minute openings. Fever present. No sugar in "urine.
M. A huge red swell- ing on the back with numerous openings. Duration? 2 weeks. Fever present.
A huge red swelling on the back with many small openings? 13 days, high fever. Urine?free from sugar. A painful swell- ing of the left middle finger and hand-?discharging pus. Duration? 6 weeks. He was operated twice and is a
diabetic (sent by Dr. Ajmal Khan).
A painful swelling near the anus? 2 months.
M
M.
M.
M.
M.
A big red swelling on the right temporal region with many small openings in the centre. Size 4" X 3"? 11 days. Sugar in urine.
A painful swelling of the palm of the left hand with fever?12 days.
A big painful swelling in the right gluteal region ?1 week. High fever.
Diagnosis Details of z-ray
treatment
Carbuncle
Do.
Do.
Cellulitis and osteo- myelitis (the latter condition was verified by x-ray examina- tion).
Abscess (ischio- rectal).
Abscess
Filters?4 mm. Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?small. Dose?200 r.
Filters?0.5 cu. -f- 1 mm. Al. Current?4 ma. at 180 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?200 r.
Filters?0.5 cu. + 1 mm. Al. Current?4 ma. at 180 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?175 r.
Filter?0.3 cu. -f 1 mm. Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?125 r weekly
Filter?0.3 cu. + 1.0 Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?125 r weekly.
Factors as above. Dose?150 r.
Dates on which the treatments were given
Total number
20-4-40
17-6-40 and 19-6-40.
18-6-40
Results
The pain was' relieved after the first sitting. The swelling gradually sub- sided and the wound healed up in about 2 weeks.
The swelling gradually sub- sided and the whole thing healed up in about 6 weeks.
Healed up in 6 weeks.
Made a com- plete recovery without any further surgical aid.
The swelling subsided com- pletely and has not recurred since.
Made an uneventful recovery.
Swelling and pain subsided completely.
The pain was much less after the irradiation and the abscess burst 2 days after.
86 THE INDIAN MEDICAL GAZETTE [Feb., 1942
Table?concld.
ber
741 R.B. 50 M.
812 B. 39 M.
832 H.S. 50 M.
836 S.N.G. 35 M.
Clinical history and findings
A very painful red swelling on the tip of the nose and high fever.
Painful swelling in the right axillary region.
Painful swelling in the region of the left parotid and fever?1 week.
A painful swelling in the left leg with several
_
A painful swelling on the tip of the nose.
Diagnosis
Boil
Abscess
Do.
Carbuncle
Boil
Details of x-ray treatment
Filter?1 mm. Al. Current?4 ma. at 100 kv. Distance?30 cm. Portal?small. Dose?150 r.
Filters?2 mm. Al. Current?4 ma. at 120 kv. Portal?8 X 10 cm. Dose?200 r.
Filters?0.3 cu. + 1 Al. Current?4 ma. at 150 kv. Distance?30 cm. Portal?8 X 10 cm. Dose?150 r.
Factors and dosage as above.
Filters?1 mm. Al. Current?4 ma. at 100 kv. Distance?30 cm. Portal?small. Dose?125 r.
Dates on which the treatments were given
6-9-40
14-10-40
Results
Marked relief and complete regression.
Relief in pain. The abscess was subsequently opened for draining pus.
Subsided completely.
Subsided gradually.
last two and a half years, by ?-rays. I admit
that the number is too small to make any
sweeping statement about the success of this
treatment, but I was struck with the rapidity of improvement, the relief of pain, and the
regression of the inflammatory process in these cases. The cosmetic result was extremely good and the healing was quicker than could be ex- pected by any other means, including surgery. The accompanying photographs show the re-
sult of rr-ray treatment in one of my cases of carbuncle recorded here. I am convinced that with rr-ray treatment the
involution occurs more quickly, the amount of necrosis is decreased, liquefaction takes place more rapidly and is less extensive, and the course of the disease is greatly decreased and at times aborted entirely, when treatment is
given sufficiently early. Mode of action of x-rays in such inflam-
matory conditions.?Various explanations have been advanced to account for the favourable influence of arrays on inflammatory conditions and the multiplicity of such explanations prob- ably has led many physicians to discredit the
clinical evidence or to ascribe it to over-
enthusiasm of the axray therapist. Indeed, without a satisfactory and convincing explana- tion it would be difficult to believe that the same
agent can be therapeutically effective against so many different forms of inflammation in different organs or parts of the body. And yet the reason appears to be quite simple and to
rest on sound and abundant experimental facts. For radiation to act in much the same way, and at the same time on so many forms of acute
inflammation, the lesions must have some com- mon factor. Now, what may this factor be? The exceptional radio-sensitiveness of certain
leucocytes, notably the lymphocytes, has been demonstrated and established by the early experiments of Heineke and has since been fully confirmed by many others. All the clinical circumstances indicate that inflammatory lesions respond to irradiation in proportion to the degree of leucocytic infiltration, and that the rays act primarily by destroying the infiltrating cells. In favour of this view are the experimentally proved sensitiveness of lymphocytes on the one hand, and on the other hand the fact that the
Feb., 1942] SULFANILAMIDE IN ASCITES : JEEVANADAM & OTHERS 87
rate of regression of acute inflammatory pro- cesses corresponds to the rate at which lympho- cytes are known to be destroyed by Eradiation. The rapidity with which the symptoms often
abate and the physical signs disappear after exposure to a small or a moderate dose of x-rays Indicate that the destruction of lymphocytes is he primary and direct result of irradiation, the lymphocytes are the only cells in the body, e^cept the basal epithelium of the salivary ?Jands, which react to irradiation in such a short 1I;ne and at such a rate. Also variation in the degrees of leucocytic infiltration in different Patients may explain the partial or complete ailure of irradiation in some cases. If it can e assumed that the leucocytes which the
0lganism mobilizes around the site of infection
^present an effort to localize the infection and o dispose of the infectious material, it must also e assumed that the infiltrating cells contain or
elaborate within themselves the protective sub- dances which enable them to destroy or neutral- lz.e the bacterial or other toxic products which give rise to the inflammation. If these assump- i?ns are well founded it seems reasonable to
? e^uce that irradiation, by destroying the
nhltrating leucocytes, causes the protective ^stances contained by such cells to be derated and to be made even more readily available for defensive purposes than they were n the intact cells.
Conclusion.?'The evidence of the therapeutic value of x-ray treatment in acute inflammatory c?nditions like boils and carbuncles is so
abundant and so generally favourable that one bonders why this method of treatment is not ttiore widely, used. Perhaps the very multi- Phcity 0f inflammatory lesions in which x-ray , erapy has been claimed to be effective has leu
not unnatural scepticism; or failure to utilize *}e treatment may be due to an excessive fear
ot ill-effects?a fear probably springing from rePorts of x-ray injuries incurred during treat-
ment of malignant tumours with very large aoses of x-rays, or from systemic reactions which go often follow irradiation for conditions
requiring prolonged exposures. But in view of Ule short exposure and small doses required for acute inflammatory lesions, such as those
j^entioned in this paper, such fears have no
BIBLIOGRAPHY
Kaplan, I. I. (1937) .. Radiation Therapy. Oxford University Press, London.
A(?Kee, G. M. (1938). X-Rays and Radium in the Treatment of Diseases of the Skin. Henry Kimpton,
, London.
?j?cK, H. E., Pemberton, Principles and Practice of ^d Coulter, J. S. Physical Therapy, 3. W. F.
p y<**). Prior Co., Haggerstown.
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