An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. 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.
![the (lan^'crs of delay are very great. An abscess in tlie neighborhood of the appendix verniifonnis may produce a fatal peritonitis if allowed to remain unopened. ])eep-seated abscesses of the neck may burrow widely, and mav seriously interfere with res])iration by pressure upon the trachea. An abscess near the rectum should be opened as soon as induration is discovered, in order to prevent a fistula. If no pus has formed the incision may prevent it. The incision, as a rule, should be a free one, and so made as to favor drainage and to leave the least conspicuous scar. The finger should then be introduced to determine the size and situation of the various pockets. In case of abscesses near large vessels or other important structures Hilton's method may be used to advantage. This consists in making an incision through the skin and deep fascia by the knife. The seat of the pus can be ascertained by pushing in a pair of closed hemostatic forceps or blunt scissors or a sinus dilator, and the opening so made can be easily enlarged by drawing them out open. If neces- sary, to facilitate the escape of the pus by gravity, a counter-opening can often be made by pushing the hemostatic forceps entirely through the tissues to the opposite skin, and cutting between its partly opened blades. The cavity of the abscess should be thoroughly emptied, curetted, and syringed out with anti- septic solutions. These may consist of corrosive sublimate 1: 5000 or carbolic acid 1: 100, or if a milder antiseptic fluid is needed phenyl (sulpho-naphthol) 1: 250. When the pus. and sloughs have been thoroughly removed in this way, a drainage-tube of a sufficient size should be inserted, and retained either by a safety pin inserted through its extremity or by stitching it to the skin to avoid its falling out of the abscess, or, still worse, of being lost in its cavity. An antiseptic poultice (made of aseptic cotton and cheese-cloth and wrung out of a weak antiseptic solution) may be applied, or a dry absorbent dressing may be used. In freely-discharging abscesses the dressing should be changed at the end of twelve hours or less, and the cavitv Avashed out again. The fountain syringe fitted with a tube ending in a conical glass point is well adapted for this purpose. It gives a continuous stream, and causes but little pain to the patient in its application. In a few days the inner surface of the abscess-wall cleans off and healthy granulations make their appearance. The tube can be shortened daily as the cavity shrinks, but the time of its removal will depend entirely upon the length and ramifications of the cavity. Cold abscess is caused in the great majority of cases by tubercular infection, although occasionally it may be of syphilitic origin. In the ordinary tubercular cold abscess we find a peculiar membranous wall formerly called the pyogenic membrane (the pyophylactic membrane of Park), which is readily scraped off and is infiltrated Avith tubercles. In the syphilitic abscess no such condition exists. This membrane, as also the pus of cold abscess, is more fully described in the chapter on Tuberculosis. The organisms found in the contents of the abscesses before they are opened are the bacilli of tuberculosis. Sometimes before, and always after they have opened spontaneously or have been opened without due antiseptic precautions, there is added the infection with pyogenic cocci, or the bacteria of putrefaction. This is an example of what is called mixed infection. Clinically, we find few of the symptoms of acute abscess. There is in most cases no redness of the part until the abscess is about to break. Pain and heat are usually wanting. The swelling is frequently quite large and fluctua- tion is distinct. Such abscesses may exist for months before they burst. Dur- ing their formation the constitutional disturbance is usually slight. There may be, however, considerable emaciation due to the progress of the tuberculosis. The temperature is usually slightly raised, and in cases of doubtful diagnosis](https://iiif.wellcomecollection.org/image/b21217014_0079.jp2/full/800%2C/0/default.jpg)
