A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland.

James Copland

Date:: 1844-58

Credit: A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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$becomes more elevated, prominent, and softened at the centre of the surface. The redness and tension undergo a similar change. The circum- ference of tiie inflamed surface is restored in some degree to the natural state ; but the more promi- nent part acquires a dark red tint, afterwards a bluish hue, and yields more and more to the pres- sure of the subjacent pus. For some time pre- vious to this siage the tumour evinces a more or less distinct fluctuation when suitably examined, and this sign becomes more manifest as the abscess advances to the surface. 48. When an abscess forms in deep-seated parts or viscera, particularly those protected by solid envelopes, or by thick and unyielding structures, the diagnosis rests entirely upon the nature of the constitutional disturbance, and the disorder in the functions of the aflfected organ or part, and here the physician should seize and appreciate the slightest difference taking place in the pulse, the animal heat, and the state of all the natural and organic functions. In these cases he requires the most exquisite tact for examination in order to arrive at an accurate opinion. The symptoms which siiould guide him in cases of this descrip- tion will be stated when I treat of the diagnosis of the diflferent kinds of visceral abscess. I may, however, remark at this place, that even in parts much less deeply seated, when the cyst of an abscess is greatly distended and very tense, fluc- tuation generally is extremely obscure, or even not to be felt, altliough its contents may be very fluid. Also, when the purulent matter is con- tained in no distinct cyst, but is disseminated through the textures, or infiltrated between fasciae or muscles, or is confined beneath apo- neuroses, great incertitude may exist as to its form- ation. The parts in such cases present more of a diffused oedema than of a fluctuating tumour; and if fluctuation can be at all felt, it is only ob- scurely. 49. It must be evident that the more feeble and latent the phenomena of the precursory in- flammatory irritation, the more difficult is it to de- termine the period at which the elaboration of pus commences. We frequently ob-^erve in practice, particularly after phlebitis, injuries of the head, fractures, and capital surgical operations, abscesses form in the liver, mediastinum, lungs, kidneys, or ovaries, preceded merely by obscure and occa- sional pain, and furnishing no certain symptoms of a local kind, by which we can decide as to their formation, until the time that iliey appear exter- nally, or are detected upon post murtein examin- ation. In cases of this description, the constitu- tional symptoms are our chief guides ; but even these are often so uncertain and so imperfectly developed as to leave us in doubt. 'I'he accession in this ob'-cure manner of internal abscess is particularly remarkable as respects those which supervene on inflammatory disease existing in other piirts, particularly to phlebitis, and which 1 have denominated cDiisecnlive abscesses. (See Veins — iiijlumrnation of.) 50. Sympioinatic abscesses generally escape detection until they advance externally. Previous to this, pain, uneasiness, tumefaction, &c., are only felt chiefly in the pari originally aflfected. ]5ut the symptoms already noticed (§4f)—48.). espe- cially llie uiiheallliy as|)cct of the surfac, the state of the febrile action and of the pulse, the niglit perspirations, the disorder of the respiratory and alvine functions, will generally serve, in con- junction with the changes in the part to which symptomatic abscesses extend, to indicate the nature of the mischief. 51. It is important, as M. Dupuvtren has very justly remarked, to take into account, when determining the existence of abscess, the greater disposition inherent in some constitutions to form purulent matter. In some persons, the least irri- tation is followed by the suppurative process. This is particularly the case in persons of a pale visage, of a soft flaccid state of the diflferent structures, and of the lymphatic temperament. It it also remarkable in those whose vital ener- gies have been lowered by previous disease ; by chronic afl^ections of the digestive mucous sur- faces ; and by those diseases which require the performance of amputation, or other important surgical operations. When the suppurative pro- cess has continued for some time, and has after- wards been suddenly stopped by an operation, or any other ac.ive treatment, the disposition to form abscesses is generally remarkable. A similar re- mark may be extended to the sudden suppression of any accustomed secretion or discharge. The most familiar instance of this kind is noticed in the breasts of nurses, which are extremely liable to suppuration upon interruption to the secretion of milk. These considerations should have their due weight with us when estimating the signs of the existence of internal abscess. Those symp- toms which are peculiar to collections of matter formed in each of the internal viscera are pointed out in their respective articles. 52. IV. Of THE Prognosis OF Abscess. The danger Irom abscesses is in proportion, 1st, to the extent of their internal surface; 2d, to the depth a' wiiich they are seated ; 3d, to the indolence of their action, or the deficiency of vital action ac- companying them; 4th, to the severity and danger of the disease by which they have bee.i occasioned ; 5th, to the sinking or deficiency of the constitutional powers under them ; and, 6tl), to the severity of the symptoms accompanying them, or produced by them. These positions are so obvious, that no remarks need be offered in support of them. [ may, however, observe, tliat abscesses seated in internal viscera are always attended with danger; but the degree of danger will depend upon numerous circumstances con- nected with their seat, the direction which they take, the state of the vital energies of the frame during their progress, the chances of their evacu- ation, and the means of reparation and renovation the constitution may still possess. 53. The prognosis of chronic, symptomatic, and consecutive abscesses depends as much upon the nature of the preceding disease, as upon the state of the abscess itself. In chronic abscess, the danger is in proportion to the extent of the surface of its parietes, and to the gratle of consti- tutional vice. In symptomatic abscess, the danger depend- almost wholly upon the nature and extent of the original disease, of which it is the conse- ([uence, and upon the largeness of surface extend- ing thenc • to the ultimate limits nf suppuration. In consecutive abscess, the danger is extreme ; owing, in many cases, to the nature of the primary <iisease, the depresseil slate of th • constitutional powers, and to the vitiation of the circulating$