Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.
- Mansell-Moullin, C. W. (Charles William), 1851-1940
- Date:
- 1893
Licence: Public Domain Mark
Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
56/1262 (page 48)
![When the abscess is of any size, the existence of fluid is detected by what is termed fluctuation—the wave felt by the fingers of one hand when [pressure is made with the other upon a distant part. With large collections of fluid this can be made out at once, the amount of the displacement is so great; but with small ones, especially when they are deep-seated or tied down by unyielding sheets of fascia, it is often a matter of extreme difficulty. At the same time it is impossible to overrate its importance. The further apart the fingers of the two hands can be placed the better. The pulps, not the tips, should rest upon the .skin; two should be used if possible, but in many instances there is only room for one of each hand; those of the one should maintain a slight but perfectly uniform pressure upon the skin, those of the other should be gently but firmly pu.shed down at short regular intervals, and before a definite opinion is formed the action should be reversed. Of course, fluctuation, even when the diagnosis is correct, can only be taken as a proof of the presence of fluid ; it is no ]jroof of its nature, which may or may not be inflammatory. In testing a part of the body in this way there are many sources of fallacy. An excellent imitation of fluctuation is obtained over a healthy muscle if the hands are placed side by side upon it, so that the wave is transverse. Soft, solid growths are so perfectly elastic that the .same sensation is produced over them, and, though the distinction is of less importance, as suppuration is almost sure to follow, areolar tissue infiltrated with inflammatory oedema often fluctuates dis- tinctly ; fluid is actually present, but instead of being confined in one central cav- ity, it is spread about in the loosely woven and softened network of fibres. In deep-seated abscesses, especially those which are tied down beneath dense sheets of fascia, as in acute periostitis, the oedematous swelling in the looser and more superficial tissue is so great that this false sense of fluctuation is all that can be felt. As, however, in itself it is almost diagnostic of the condition beneath, this is of less importance. In addition to this, the character of the pain changes as suppuration sets in. TJu-ohhing is met with under other conditions, but it is seldom or never absent when pus is forming rapidly, especially if it is tightly bound down, and tenderness too often becomes much more distinct and localized. Constitutional.—The fever that attends the formation and discharge of pus is in many respects highly characteristic. At the commencement this is very often a rigor or shivering fit. This begins with a sense of chilliness, or actual cold, which may last only a few minutes, or may continue half an hour. At the same time there is a feeling of extreme prostration. The skin is pale, livid, and rough ; the face is pinched ; the eyes are sombre and surrounded by dusky rings ; the respiration is hurried and shallow; and the pulse small, frequent, and feeble. Even at this time the tem- perature is higher than normal ; the rise begins before the shivering, continues all through it (so that while the teeth are chattering the skin is scorching), and through the period of dry, burning heat afterward, until sometimes it reaches io6° F. As soon as it ceases, profuse perspiration sets in, the temperature begins to fall, the face becomes flushed, the involuntary muscular fibre in the skin relaxes, the natural texture returns, and there is a sensation of profound relief, although the weakness and exhaustion afterward are often extreme. Not unfre- quently a herpetic eruption makes its appearance around the lips the day after a rigor, and in some cases spreads over the lower j^art of the face. Typical rigors are by no means confined to the onset of suppuration. They occur at the commencement of many of the specific fevers, and in pneumonia and pyaemia. The first passage of an instrument down the urethra may cause one, or the first micturition after an operation. Those who sufter from ague are particu- larly susceptible to the urethral form, but nothing of the kind has been proved in reference to others. In children vomiting and convulsions occur instead, and in acute catarrhal inflammation, and sometimes in other forms, there is a succession of slight chills, la.sting for many hours, instead of one definite one. The ultimate](https://iiif.wellcomecollection.org/image/b21213744_0056.jp2/full/800%2C/0/default.jpg)
