Special Sub-Topic: Carbuncles, Boils and Erysipelas Click Here To Play: Carbuncles, Boils and Erysipelas

A common feature of carbuncles and boils and many other infections is the formation of pus. Which of the following is NOT a constituent of pus?

sebum (oil). Pus is usually a yellowish colour. If it is red, it indicates the presence of blood, usually due to ruptured blood vessels. If it is blue or green, it indicates the presence of particular species of bacteria, such as Pseudomonas aeruginosa which causes a variety of infections including folliculitis, urinary tract infection and ear infection.

Erysipelas is a contagious disease characterised by deep red inflammation of the skin. What is another name for erysipelas?

Saint Anthony's Fire. This disease is known as Saint Anthony's Fire because it was believed that Saint Anthony was the source of many miraculous cures during a outbreak of erysipelas in the 11th century. Erysipelas is caused by the Streptococcus pyogenes bacterium. "Pyogenes" means "pus producing".

A boil is a bacterial skin infection characterised by a painful, hard pus-filled lesion. What type of bacteria causes boils?

Staphylococcus. A boil is a skin infection which usually involves a hair follicle and is caused by Staphylococcus (usually S. aureus, commonly known as "golden staph"). Another name for a boil is a furuncle.

A carbuncle is a cluster of boils. What type of patient is more likely to suffer boils than the average person?

all of the answers are correct (a male patient, an elderly patient, a sufferer of diabetes). Carbuncles are much more likely to affect males than females. Diabetes and old age are also major predisposing factors. Carbuncles are most commonly found on the back of the neck.

Sir Arthur Conan Doyle wrote a Sherlock Holmes story called "The Adventure of the Blue Carbuncle" (1892). What was the "carbuncle" referred to in this story?

a blue gemstone. The ancient Romans used the term "carbuncle" to describe both a red gemstone and an inflamed boil or tumour. The word is derived from the Latin for "small (live or glowing) coal", a reference to the red colour of both the lesion and the stone, as well as the heat associated with the inflammation. With respect to gemstones, nowadays the term carbuncle is only used to refer to garnets cut in a certain way (without facets or "en cabochon"). There is no such thing as a blue carbuncle. Was Conan Doyle displaying his ignorance of geology or was he taking artistic licence?

Which of the following is NOT another name for the plague?

The Great Epidemic. Plague is caused by a bacterium called Yersinia pestis. The bacterium resides in the fleas which live on rats. The disease is transmitted to humans by the bite of the rat flea. Throughout history there have been epidemics of plague, such as the Black Death of the 14th century, the Great Plague of London in the 1660's and the Oriental Plague of the 1890's. Contrary to popular belief, plague is not a disease of the past. It is still with us today in many parts of the world, even in America.

A characteristic sign of plague is the appearance of hard, painful lumps which were often as large as an orange and typically located in the neck, under the arms and in the groin. They would turn black, split open and ooze pus and blood. What is the medical term for these lumps?

buboes. The buboes are in fact the victim's infected lymph nodes. The term buboes is derived from the Greek "boubon" which means "groin or swollen gland", which is where the word "bubonic" came from.

Which Mother Goose nursery rhyme is said to be about the plague?

Ring Around the Rosey. There are many versions of "Ring Around the Rosey", also known as "Ring-a-Ring o' Roses". There is some debate as to whether this nursery rhyme really is about the plague. In all likelihood it is an "urban myth". According to some sources, the first line refers to the first sign of the plague - infection with round red sores. The second line, "a pocketful of posies" refers to the fact that the sores smelled foul so people would carry or wear flowers to mask the odour and in the belief that it would help ward off the disease. The third line varies. In one version it is "a-tish-oo, a-tish-oo" (referring to the symptom of sneezing although sneezing is a symptom of pneumonic plague not bubonic plague). In another version it is "ashes, ashes" (referring to the fact that plague victims were burned to try to reduce the spread of the disease and/or that the products of their coughing and sneezing resembled ashes). And in another version, it is "upstairs, downstairs" (referring to the fact that all social classes were affected). The last line "we all fall down" refers to the death of the victims.

The book of Exodus tells the story of the departure of the Jews from Egypt, where they had been slaves. Initially Pharaoh refused to let them go. As a result, God brought ten plagues upon the Egyptians. Which plague was the plague of boils?

sixth. According to Exodus Chapter 9, verses 8-12, God told Moses to take a handful of ashes from a furnace and throw the ashes into the air. The ash spread out as a fine dust over Egypt and everywhere the ash landed resulted in boils that became open sores upon every animal and human being.

Which comedy group was responsible for the "Medical Love Song" which contained references to a variety of sexually transmitted diseases, pustules and buboes and concludes with "I've left my body to science, but I'm afraid they've turned it down".

Monty Python's Flying Circus. This song is from "Monty Python's Contractual Obligation Album" (1980) and is totally unsuitable to be reproduced here. It was written by Eric Idle and Graham Chapman. Graham Chapman was a qualified doctor. He only practised medicine for a few years, however, his medical training did not go to waste as he later co-wrote some episodes of the "Doctor in the House" series and Monty Python sketches are liberally laced with medical themes and jokes.