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.

    22/1104 (page 10)
    and if it be true that all other ahscesses are but symptoms of some local or general morbid condi- tion, more especially may the same be alleged of this. There are, as we observed before, two kinds; one produced by local injury, such as infiltration of the areolar tissue with urine, or with fetid exu- dation from a wound or some other poison ; the other resulting from the action of the more violent blood poisons, which ca.use wide exudation of a matter difficult of absorption, prone to run into a state of liquefaction, and incapable of becoming organised, like healthy fibrine into a sac, which shall circumscribe the liquid part of the exudation and prevent its wide dilfusion. [See Inflammation.) The points in which the diffused abscess differs from the common acute abscess, are these:— Swelling is flatter, more widely spread; not ele- vated in one centre;—redness also not most in- tense at the centre, and gradually vanishing, but extending in irregular patches ; perhaps abruptly defined — redness sometimes absent; —sometimes of a peculiar and unusual hue; heat and pam are generally intense; in some cases they may be absent Want of tendency to point in one place ; and a hard brawny, or a doughy, or oedematous, or obscurely fluctuating swelling are other character- Tlie local progress of this kind, of abscess is as f(,]lows — First comes unhealthy exudation, which spreads and infiltrates the areolar tissue. It may Toe firm and brawny ; or almost entirely liquid from the first, consisting of a turbid yellowish serum It may occupy great space and extend great distances, filling the entire subcutaneous areolar tissue of a limb, or of one side of the trunk. It Boon causes inflammation of the skin, whose vita- lity is seriously interfered with from the state ot the subcutaneous tissue, and which exhibits vesicles filled with serum, straw coloured, or yellow, or livid At these points the skin afterwards ulce- rates or sloughs, giving exit to copious puriforra discharge with flakes of dead areolar tissue which come away often like masses of wet tow Large tracts of skin may perish in this wajs and all the areolar tissue may perish from the surface and inter- stices of the muscles, leaving them as though cleanly dissected. The work of granulation may succeed vigorously, but cicatrisation must of necessity be Blow under such circumstances, and the muscles be left embarrassed and the joints permanently bent. The constitutional symptoms which accTOpany such a state of things are those which are some- tiroes described as sjTnptoms of irntalive fever, or pycBinia; or of typlioid symptomatic fever. Rigors followed by intense excitement of the heart ; pal- pitation and anxiety at the chest ; rapid soft pulse ; dry brown or glazed tongue ; possibly bilious diarrhoea, or dysentery ; possibly delirium ; pos- sibly a preternatural calmness and clearness of mind. If relief be not given, the patient sinks, and death is perhaps preceded by squinting and convulsive twitchings. The great variety of causes which rnny give rise to diffused abscess must of necessity occasion great difference in the details. These may be learned by consulting the articles Extravasation OF Urine, Compound Fkactukb, Gunshot Wounds, Poisoned Wounds, and Dissection Wounds ; whilst the details of cases arising from constitutional causes will appear n. the articles Pyemia, Erysipelas, and Glandbbs. In cases in which the malady arises from a vitiated state of the blood, operating on parts ' ' ' have received no injury, it is surprising which - J ^, how suddenly the whole process may be accom- plished. A woman, for instance, whose womb has imbibed an erysipelatous poison after child-birth, and who has shivered, and is suffering from abdo- minal pain and tenderness, and suppressed milk and lochia, may be struck as it were with a sudden pain in one shoulder or elbow, which after a short time may vanish entirely, and be succeeded by pain in the calf of the leg, which speedily red- dens, and in a few hours may be a bag of pus ; and in some cases this is accomplished with little if any pain. From cases of this kind the student may learn the purport of various terms which have been ap- plied to aliscesses. For example, a distinction may be made between abscess in a part, and abscess of a part. In the former, suppuration occurs in a part previously healthy, which is selected as the spot for accomplishing a work ol elimination ; in the latter, the suppuration is pro- duced by a diseased state of the part itself. Ab- scesses by which the separation of a materies morbi was assumed to be effected were formerly often called critical ; they have also been termed conse- cutive, and metastatic; although the last word, m its ordinary signification implies more than can quite be proved ; that is, it implies that pus, in the form of pus, is taken up from one part and deposited in another, of which there is no proof. (See PvasMiA, Phlebitis.) One kind of abscess may improperly be called diffused; and that is abscess underneath hard fascia, and in the sheaths of tendons; the pus cannot get through these, and so spreads underneath them ; and very serious cases they are ; but their diffusion arises from anatomical peculiarities, and not from any thing special in the kind of exudation. We have now described the three chief forms in which abscesses may present themselves, no matter from what cause they may anse Hut it must be borne in mind that imiumerable shades and gradations exist ; for example, m the. mten- sitv of the inflammation which shaU accompanj the first stage of an abscess, and in the degree of led contamination which shall be the cause of it • and that allowances must be made, in this as in'other cases where things are treated of m a general way, for the difficulty of presenting one set of facts without seeming to ignore another. Every gradation may occur between a hcaUl;y acute abscess, concentrated to one point rapidly suppurating, pointing, bursting, and healing up, affile JieaUhy diffused abscess, with its imper- fect limitation, and suppuration in pat<=hes here and there, and widespread destruction of he areo- lar tissues. So every variety may exist m the decree of healthy sthenic feverishness, and of un- hea tl y irritatd fever ; and every variety between the acute and chronic abscess in tlie amount of nd'riidity with which the diseased pro- cesses are beg, carried or, a d e ed. ^^^^^^ ,ar^;y:ts:>^-^^^--^''V''tS iigi ij, .1= ^ ,„ sav. thev may be classi- flainma ,on b'* « ''j^^J^ L. 1? Abscess result- lied under these thiee iieaas. ^. j- „.j„_ ing purely from the localisation of blood disorder, including dl scrofulous, and cachectic, and cri ical and eliminative abscesses ; all abscesses resulting