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

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.

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$cause is unknown. No doubt, from the symi)tonis, they are due to the action of the nervous system, the medulla oblongata and the higher centres that control the production of heat in i)articular, but it is not known what the stimulus is nor how it acts. The suppurative rigor and that which heralds acute specific fevers may be caused by the absorjjtion of some poi.son into the blood ; and Harrison believes that this is true of urethral ones as well, the ptomaines present in the urine being al)S()rbetl through abrasions of the mucous mem])rane after micturition ; but it is more probable that these are due to reflex irritation, whatever ma)' be the cause of the others. The subsecpient course of the fever in acute suppuration dej^ends upon the amount of absorption. In deep-seated inflammation the temperature frequently continues to rise until the wall of granulation-ti.ssue is establi.shed ; then it usually drops slightly of a morning (rarely a degree), rising again to its former level of an evening. As soon as the abscess is opened and tension relieved, absorption ceases altogether, the temperature falls to the normal, and if the drainage is what it ought to be, and decomjwsition does not occur, it does not ri.se again. Suppurative fever must be distinguished from septic fever, although the two often occur together. If the sui)purative variety occurs alone, it pursues the course already described, the severity depending uj^on the tension. Sometimes, therefore, as in thecal abscess or whitlow, although the amount of pus is very small, the constitutional symptoms are exceedingly sever.e. If the two are present together they cause hectic, the temperature continues to rise of an evening (although it may be normal of a morning), and the strength of the patient fails until, if the cause is not removed, death ensues from ex- haustion. If sei)tic fever occurs, suppuration is sure to follow, unless the case proves fatal too soon. In a recent wound—a compound fracture, for example—in which the planes of cellular tissue up and down the limb are filled with extravasated blood, traumatic fever sets in first, with or without shock. Then, if decomposition takes place, septic fever follows, the limb becomes red and swollen, the tempera- ture rises, delirium sets in, and the patient may die from acute blood-poisoning before there is time for suppuration. If he escape this, the pyogenic organisms gain access to the part, the tissues, injured already by the action of the septic poison, melt away as pus, and in five or six days the fever begins to assume the suppurative type. After a time, unless the result is fatal in the meanwhile from exhaustion and hectic, the structural elements around regain their strength, a barrier of granulation-ti.ssue is thrown out, the temperature falls of a morning, although it still continues to rise in the evening; and by degrees, if no further injury is inflicted, the suppurating area contracts, the absorption of the products of decomposing pus ceases, and the fever subsides. Varieties of Abscess. Acute or Phlegmonous Abscess.—This is usually taken as the type of an abscess. All the symptoms are present, constitutional as well as local, and they are severe in proportion to its size and the degree of tension. Throbbing pain, heat, swelling, redness, and fever are well-marked ; inflammatory oedema is always present over it, and fluctuation makes its appearance at an early period, varying, of course, according to the depth. If it is not opened it makes its way in the direction of least resistance, undermines the skin, and bursts; the cavity contracts at once, and unless some cause, such as a foreign body or a piece of dead bone, keeps up the irritation, the granulations fall together as it collapses, and repair is completed in a very short time by their organization. Metastatic abscesses are a variety of the acute form occurring in connection with pyaemia. They are sometimes described separately because of their distinctly embolic origin ; but if the view^ that suppuration is due to the action of cocci,$