Volume 1
Cooper's dictionary of practical surgery and encyclopaedia of surgical science.
- Samuel Cooper
- Date:
- 1861-1872
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.
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![C. All abscesses producing serious disturbance, or interruption, of the functions of very important organs, and thereby endangering life ; as ab- scesses of the throat, or near the larynx, or pha- rynx ; abscesses compressing the jugular veins, and threatening the patient with apoplexy or suf- focation, &c. In such cases, if the practitioner were to defer making an opening until the swelling had softened, and the abscess had been perfectly formed, the patient would be in great danger of perishing ere such changes had taken place. 7. The generality of chronic abscesses should be opened early, more especially if the means usually resorted to for promoting the absorption of the matter, present no prospect of success. By omitting to make an outlet for the matter, we allow the accumulation of it to increase, and sometimes the abscess then becomes dangerous from its mere size; the inner surface of it, or the cyst, acquiring vast magnitude. With respect to chronic abscesses, connected with diseased bone or diseased joints, and collections of purulent fluid in the synovial membranes, some directions will be found in other parts of this work. (See Joints ; Lumbar Abscesses ; Vertebra,.) Those abscesses ouglit to be opened early (says Professor Thomson) that are situated in parts through which the matter is liable to be- come widely diffused. This is particularly the case v>'ith abscesses that are situated on the fore part of the neck, or in the cavity of the axilla, or by the side of the rectum. When matter is formed in the cavity of the axilla, if it does not speedily obtain an external outlet, it is very liable to pass up towards the clavicle in the course of the axillary plexus of nerves and vessels, or for- wards under the pectoral muscle. I have repeat- edly seen axillary abscess take both of these direc- tions at the same time, forming one of the most painful and difficult cases to treat, which occurs in the management of abscesses. Dr. Thomson also considers an early opening proper and neces- sary, when the matter is lodged, as in some cases of whitlow, in the sheaths of the tendons ; when matter is formed under the periosteum ; when it collects under fasciie, or in the vicinity of large arteries, joints, or the greater cavities of the body ; and also when the abscess is deep-seated. (See On Injlammation, p. 336—338.) With respect to making an early opening into abscesses situated near large arteries, I am not .^ware that any danger of the artery ulcerating in consequence of the nearness of the pus, really exists. Therefore, some doubts may reasonably be entertained of the soundness of Professor Thom- son's advice in this particular case, as the general rule of opening abscesses near large blood-vessels, in an early stage of the disease, would be objec- tionable on the ground of the practice exposing the vessels themselves to injury. Indeed, this well- informed writer distinctly mentions, in considering the subject in question, that the arteries are not very susceptible of ulcerative absorption (p. 337). It is now a well-established fact, that arteries, and veins likewise, may ulcerate into the sac of an abscess, particularly if of the scrofulous kind. (For examples, see the Mcd-C/iir. Trans, vol. xxvi, xxix.; South's Edition of Chelius, I. 191.) More- over abscesses may burst into any serous or mucous surface that happens to be near ; lung, bowels, pleura, or peritoneum. The making of an opening in certain abscesses should be deferred longer than in common in- stances. Such are collections of purulent matter, situated in internal organs, as the liver, spleen, kidney, and lungs, and producing an outward swelling. Dupuytren deems it most prudent not to open such tumor until the skin is inflamed, the only circumstance which can be depended upon as denoting the formation of those adhesions, by which alone the insinuation of the pus into the great serous cavities will be prevented. — [R. Druitl.] ABSORPTION. This word signifies the pro- cess by which any substance whatever, solid, liquid, or gaseous, passes into the blood-vessels of a living animal._ It is used, also, by writers of the past generation, as synonymous with atrophy, emacia- tion, or wasting. The idea of absorption is so associated in the minds of moat surgeons, with the name of John Hunter, that we will commence by giving an ac- count of the very elaborate doctrines which tliis great man taught, although they are now quite superseded by the more simple and truthful views of the present generation. The leading idea, which runs through all Hunter's speculations on this matter, is, that absorption is an active process, an operation, or action, per- formed by the mouths of the lymphatics, or, as he calls them, the ahsorhent vessels. My concep- tion, he says, is that the whole operation of ab- sorption is perfomied by an action in the mouths of the absorbents. Physiologists, he says, have supposed that the action of these vessels was similar to that of capillary tubes. But capillary tubes can only imbibe liquids, whereas solid matters, such as sciiThous tumors, and bones, may be re- inoved by the absorbents. Therefore, he con- tinues, unless we assume the existence of some solvent, to reduce these solid parts to a liquid state, such as would enable them to be imbibed by capillary tubes (which we have no proof of), we must suppose some action in the mouths of the absorbent vessels, capable of effecting the same purpose. Consider, he says, the mouths of ditterent animals, and I will venture to say that the mouths of all the different animals have not a greater variety of substances to work upon than the absorbents have ; and we may observe that with all the variety of mouths in different animals, this variety is only for the purpose of enablinr^ them to absorb solids, which admit of every variety of form, texture, &c., every one being capable of absorbing fluid matter, which admits of no variety. Such, in Hunter's own language, were his ideas of the mechanism of absorption, and the action of what he called the ahsorhent vessels Respecting the uses and oper.itions of these vessels, he considered them (to use his own words) in two views ; first, as they absorb matter which IS no part of the macliine ; secondiv, as they absorb the machine itself. ' The first of these is the well-known use, the absorption of matter which is no part of the ma- chine.^ This 13 of two kinds ; one, exterior matter, in which may be reckoned everything applied to the skin, as also the chyle ; and the other, interior, such as many of the secreted juices, such as fat, and the earth of bones, &c. These arc principally with a view of nourishment, and also answer many other purposes; so that the action of absorbing](https://iiif.wellcomecollection.org/image/b21461806_0001_0025.jp2/full/800%2C/0/default.jpg)
