Volume 2

Lexicon medicum; or medical dictionary : containing an explanation of the terms in anatomy, physiology, etc / [Robert Hooper].

  • Robert Hooper
Date:
1831
Catalogue details

Licence: Public Domain Mark

Credit: Lexicon medicum; or medical dictionary : containing an explanation of the terms in anatomy, physiology, etc / [Robert Hooper]. Source: Wellcome Collection.

    19/1324 (page 9)
    which were before contiguous become se- parated, or depart from) each other. — See Apostema.) An abscess, called likewise Abscessio, Imposthuma, Apostasis, begins by an inflammation in the cellular membrane, or fleshy parts, which is attended by obtuse or acute pain; the part soon becomes tumid, and the tumour spreads, becomes painful to the touch, pus forms in it, and a fluctuation is perceived. In whatever part an abscess is seated, it will sometimes spread to a won- derful extent, and be loaded with a prodi- gious quantity of pus. In all such cases, the first stage of inflammation must have been overshot by the violence of the action, or from some other cause, and the suppurative and ulcerative have commenced simulta- neously from the first. For otherwise the coagulable, or, as Mr. Hunter prefers to call it, the coagulating lymph thrown forth, into the cellular membrane in the earliest stage of the inflammation, would have formed a boundary wall by the production of new vessels and reticulations, much nearer to the salient point of the inflammatory action, and confined the secretion of pus to a much nar- rower limit. The secretion of coagulable lymph, and the reticulate adhesion and formation of new vessels which issue from it, is indeed de- signed to prevent the necessity of the sup- purative and ulcerative stages of inflamma- tion ; and the natural cure of the adhesive stage is by resolution. When, therefore, an abscess takes place in a healthy frame, or, in other words, when the inflammation passes into the two ensuing stages of the suppurative and ulcerative, and pus is formed, and a cavity scooped out for its reception, we are to take it for granted that the instinctive and remedial power of nature is incapable of producing a cure by the first intention ; that some dead part or extrinsic substance is required to be re- moved ; and that the two ensuing stages of inflammation are had recourse to for this purpose. In the formation, then, of an abscess in a healthy constitution, we are to suppose that some pat of the organ in which inflamma- tion occurs, as, for example, some cellular membrane, or piece of a muscle, is become dead, and an incumbrance to the living parts that-surround it, instead of assisting in their office. In effecting, therefore, the important object of a cure, it is obvious that two dis- tinct actions are necessary; the dead part must be carried off, and its part must be filled up by a substitute of new matter pos- sessing the precise properties of the old. And in the process which takes place to accom- plish these two purposes, we meet with ano- ther clear and striking instance of that won- derful instinctive power which pervades every portion, both of the animal and the vegetable world, and which is perpetually stimulating them to a repair of whatever evils they may encounter, by the most skil- ful and definite methods. 3 In order to comply with this double de- mand, of carrying off the dead matter, and of providing a substitute of new, the ab- sorbent and the secernent vessels in the living substance that immediately surrounds that which requires to be removed, commence equally, and nearly at the same time, a new mode and a new degree of action. A bound- ary line is first instinctively drawn between the dead and useless, and the living and active parts; and the latter retract and sepa- rate themselves from the former. This process being completed, the mouths of the surrounding absorbent vessels set to work with new and: increased power, and imbibe and carry off whatever the material may be of which the dead part consists, whether fat, muscle, ligament, cartilage, or bone; the whole is equally sucked up and taken away, and a hollow is produced where the dead substance existed. While this is proceeding, the mouths of the corresponding secernent vessels from the first, and perhaps somewhat antecedently, commence a similar increase and newness of action; and, instead of the usual fluid, pour forth into the hollow a soft, bland, creamy, and inodorous material, which pro- gressively fills up the cavity, presses gra- dually against the superincumbent skin in the gentlest manner possible, distends and attenuates it, and at length bursts it, and exposes the interior to the operation of the gases of the atmosphere. From this period the process of incarnation commences: gran- ulations of new living matter pullulate on every side, assimilating themselves to the nature of the different substances that are lost, till the hollow is sufficiently filled up, and the organisation completely regene- rated. On the bursting of an abscess externally, we occasionally find that a portion of the dead matter still remains, which is, after- wards, gradually sloughed away, or is thrown off by a separation at its base. This is par- ticularly the case in furuncles or boils; and still more strikingly so in large abscesses that include bones or the tendinous parts of muscles which are more difficult of absorp- tion, though even these are sometimes ab- sorbed, and completely carried off. The attenuation of the superincumbent integuments of an abscess appears to be pro- duced by the stimulus of distension occa- sioned by the pressure of the accumulating pus. And it is to the same stimulus tbat Mr. Hunter resolves the absorption of the dead matter itself, conceiving that for this purpose the secretion of the pus commences somewhat earlier than the absorbent process. The formation of pus, and consequently the existence of an abscess, is evidenced by a cessation of the pain of distension, which gives way to a throbbing pain, synchronous