Volume 1

Cooper's dictionary of practical surgery and encyclopaedia of surgical science.

  • Samuel Cooper
Date:
1861-1872
Catalogue details

Licence: Public Domain Mark

Credit: Cooper's dictionary of practical surgery and encyclopaedia of surgical science. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    21/1104 (page 9)
    marked by want of power. The patient usually complains first, of a swelling, which is pale, free from tenderness, not adherent to the skin, evidently encysted. In various situa- tions, such a swelling may be mistaken for a venous cyst, a ganglion, an aneurism, or a hernia. The patient probably can give no account of its origin, unless it arises from disease of the spine, or implicate some of the great muscles of the limb, •when probably there will be an account of obscure pain and weakness for months or years; in most cases the presence of the tumor is discovered by accident. The abscess is bounded by a cyst, pale grey or ash coloured, more or less vascular, composed of adhesive or fibrous exudation. The contents may embrace every variety of pus or puriform fluid, in every stage of degeneration. They may be merely an opaque serum, or serum with ciu-dy flakes, with flakes of cheesy matter and cholesterine, or genuine pus. The contents may vary from time to time ; they may be diminished by absorption; or in- creased by fresh exudation kept up by the orio-inal source of the disease, or supplied by the inner surface of the cyst;—and this additional exuda- tion may consist of blood or pus, which were not present at first. One character of chronic abscesses, is their tendency to almost indefinite enlargement before coming to the surface and bursting. An abscess originating in diseased bone may excavate all the areolar tissue of the hips and lower part of the back, and both thighs, and contain gallons of matter. They may also make their way along the interstices of muscles, and point in the most unex- pected situations at a distance from the focus of mischief. As regards local history, the usual course is, that so soon as the chronic abscess has become suffi- ciently large to stretch the skin and interfere with Its nourishment, the distended part reddens, and soon ulcerates at one or more points, just as in the case of an acute abscess, and the matter is dis cnarged. But this process admits of very many varieties m its circumstances and results and in the consti- tutional symptoms attending it; the chief of which are the following:— _ In the first place, if the abscess result from an insignificant exudation into the areolar tissue, and It the state of health which gave rise to that exu- dation be repaired by proper alteratives and tomes, then, as we observe in the article Ab.sohp- Tio.v, both the original exudation, and any puri- form fluid to which it has given rise by its presence may be taken into the veins again, and the case be cured by absorption. Secondly, in the case of a small abscess in the subcutaneous or intermuscular areolar tissue it may burst, or bo opened, the pus escape, and then under favourable circumstances, the opposite sides of tlie cyst may at once contract and adhere, and the aperture heal. But far more freriuently there 3S a want of plastic energy in the lining cyst, so that U requires a long time to contract, during which, as in the acute abscess, the orifice may enlarge' into an ulcer, and considerable drain take place Irom thy internal surface. (See also Smus.) Thirdly, in the case of a large abscess, there are other and very grave conditions which may be ABSCESS, ' 9 added. One of these is, that from certain changes in the quality of the matter contained in the sac, the same series of phenomena may occur which we spoke of under the head of acute abscess, — viz. rigors, occurring daily, followed by a hot stage, and profuse perspirations; in fact, the symptoms of acute hectic which we have before detailed. This is not the place to enter fully into the subject of hectic. Well may Hiuiter's words be taken in their tiiie sense, .that the constitution has become conscious of a local disease or irritation which it cannot remove nor cure. Tme also was his observation that hectic does not usually come on till after large chronic abscesses are opened; and likewise his opinion that absorption of pus alone cannot be the cause of hectic. But in truth, the word ]ms embraces an immense variety of morbid products, which again may be intermixed with products of decay; and these if absorbed, may be capable of causing hectic. We may observe, as we have before said, that rigors and the other signs of hectic may exist without suppuration; and that suppuration to an enormous extent may exist without them: further that pus may be and daily is absorbed without producing hectic; yet that pus in certain stages of decay or varieties of admixture may if absorbed cause these symptoms, and does actually produce them under certain cir- cumstances. Some modern surgeons have copied Plunter and fallen into the error of asserting that hectic never occurs till after an abscess is opened. But this is absurd. The symptoms then of hectic, rigors, heat, per- spirations, red tongue, thirst, loss of appetite, diarrhoea, aphthae, pink sediment in the urine, loss of hair and rapid emaciation may occur before an abscess has been opened. But after a large abscess has been opened a worse train of circum- stances arises, which renders hectic in its severest form still more likely to come on. The surface of an extensive cyst, endowed with very feeble vita- lity, is deprived of the support heretofore rendered to it by the liquid which it contained. Hence its surface becomes loaded with blood; and its feeble vessels giving wajs exude more or less blood or serum. The injury thus occasioned sets up some degree of inflammation and feverishness. Air pro- bably gains access to the interior of the sac, and the pus, a liquid not easily putrefiable by itself; is ren- dered eminently so, by being mixed with small quan- tities of serum and blood. Hence there is a large internal absorptive surface, bathed in putrescent- fluid. And now follows a more grave set of symptoms. The patient up to the very day of the opening of the abscess, may, with the exception of debility, have been in a comfortable state of health; he may have escaped all hectic hitherto, for, as we have said, that condition appears to be incidental to abscess, and not essential, to arise from the absorption of pus in particular conditions, and not Irom absorption of pus pure and simple. But let the interior of a large sac be bathed with putrid matter, and then comes on shivering, picking of the bedclothes, dry brown tongue, restlessness, possibly sickness, probably diarrlirca, which after two or three days will be followed by death. Lastly,_it must be noticed, that the drain from an extensive abscess may slowly bring on complete exhaustion, even though there be none of the signs of blood poisoning just related. The diffiiscil abscess now comes to bo described,