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 tlieruiometer ■will give valuable inroriuation. (.)iie of the most coniiuon seats of cold abscess is the vicinity of the spinal colunin, and such abscesses are due to tubercular disease of the vertebra} (Pott's disease). The \)\\^ bur- rowino; along the psoas muscle (])soas abscess) points above or below J*(»uj»art's lig;»ment or on the thiixh external to the vessels, or it may ))oint in the lumbar region near the margin of the (juadratus lumborum muscle (lumltar abscess). Treatment.—These abscesses should be opened with every antiseptic precaution, otherwise true suppuration with hectic fever will follow from the mixed infection which inevitably occurs. They must lie tlioioughly scraped out and the wound stuff'ecl with iodoform gauze. Such treatment is best adapted to those abscesses which have few ramifications, and the walls of which are evervAvhere accessible to the curette. Treves treats psoas abscess by an opening in the loin which passes external to the latissimus dorsi and erector spinas muscles and through the quadratus lumborum and psoas muscles. The diseased vertebra is first explored, and fragments of bone are removed, and the abscess-wall is repeatedly scraped and wijied out, and also washed out with a douche of corrosive sublimate, 1 : 5000, at 100° F. The wound is then closed and dressed with an iodoform dressing retained by a bandage. The patient should be kept at rest in the recumbent position for many months. If the abscess-cavity refills, the operation should be repeated. In many cases of cold abscess it is well to evacuate the contents with the aspirator and to inject some preparation of iodoform. A large canula is sometimes necessary, owing to the thick plugs of cheesy matter which obstruct the flow of pus. The cavity is now washed out with a 3 per cent, solution of boric acid. Among the preparations of iodoform recommended is a 5 per cent, ethereal solution, but not more than three ounces should be injected for fear of iodoform-poisoning. It causes considerable pain. A 10 per cent, emulsion of iodoform in olive oil can be introduced safely. The fol- lowing emulsion is also sometimes used, and is considered safe so far as poi- soning is concerned: Iodoform 10 parts; glycerin 20 ; mucilag. gum. Acac. 5 ; carbolic acid 1 ; and Avater 100 parts. From one to three ounces should be injected, and the abscess-cavity should be carefully manipulated so as to intro- duce the drug into all the pouches. Tavo or three such injections are made at intervals of three or four weeks. A cure may not be obtained for several months. Equal parts of iodoform and olive oil may be injected freely into tubercular sinuses which have resulted from the burstinff of such abscesses. If this treatment fails, recourse may be had to incision, as above described. The general treatment consists of good food, cod-liver oil and other tonics, and a careful selection of climate. Mechanical contrivances may be needed for the support of joints or bones. Abscesses of different regions of the body ])ossess characteristic peculiarities. The most common form of abscess in the integuments is the furuncle or boil. This is caused by a growth of the cocci from the deeper layers of the epidermis doAvnward along the sheaths of the hair-follicles, and a final accumulation near the root of a hair. If the cocci are arrested in their groAvth at the mouth of the follicle, a pustule is formed, but in many cases the development contiimes doAvnAvard and a true furuncle is developed. The boil in its early stages appears as a pustule. The amount of coagulation-necrosis is considerable, and the result is a 'core Avhich is discharged Avhen the abscess breaks. A crucial incision Avill promptly arrest the groAvth of a boil in its early stages, or an application of the liquefied crystals of carbolic acid may be used if it is desired to avoid a scar. A carbuncle is a suppuration and necrosis of the subcutaneous tissue, and is situated most frequently under the thick](https://iiif.wellcomecollection.org/image/b21217014_0080.jp2/full/800%2C/0/default.jpg)
