Elements of surgery / Robert Liston.

  • Robert Liston
Date:
1846
Catalogue details

Licence: Public Domain Mark

Credit: Elements of surgery / Robert Liston. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    the pressure and insinuation of pus, and suffer along with the other tissues. The most convenient and effectual mode of opening an abscess is with a sharp-pointed bistoury, and the incision should vary in extent according to the circumstances of the case. The straight instrument, used as described and represented in the Practical Sur- gery, p. 5*, will be found to answer best in deep-seated collections ; in the more superficial it may be slightly curved. It is used as here shown, only that the edge of the knife should be turned more down- wards before the integument is divided by withdrawing it. The aper- ture must always be made at the most dependent part, which is also, generally, the thinnest; thereby a free exit is allowed to the matter. If the incision be not made in a dependent part, a considerable quan- tity of the matter wTill be retained within the abscess, and can only be evacuated at the time by squeezing the parts — at all times a very cruel and improper practice — applying compresses, &c, wrhich produce much irritation and unnecessary inconvenience to the patient. The cavity of the abscess inflames, the discharge becomes bloody and putrid, and great constitutional disturbance is apt to follow. When, again, the opening is sufficiently large, properly placed, and the mat- ter flows out through the elasticity of the covering, no air enters, the cyst gradually contracts, and the cure is soon completed. When the abscess has been deeply seated, and the incision made through a considerable thickness of healthy parts, it is sometimes, though very rarely, necessary to introduce a small piece of lint be- tween the edges of the wound, otherwise they may speedily adhere, and the discharge of the matter be in this way prevented. In con- sequence of smart hemorrhage, also, it may be proper to stuff the wound with lint, and retain it for an hour or two ; but in general the practice of stuffing abscesses, or the openings into them, is hurtful. After the incision, as already remarked, it is unnecessary and injurious to discharge the pus by forcibly squeezing the sides of the abscess ; the application of a poultice will promote the evacuation of the mat- ter, and allay the irritation. In chronic abscesses of large size, it is sometimes necessary to make a counter opening — that is, an opening in a part of the tumour opposite to the original opening, in order that the matter may be more completely discharged. Setons introduced into the cavity of phlegmonous abscesses sozne time after their eva- cuation, are highly injurious, as causing much irritation in parts which are already in a morbid state of excitement; but in chronic collections, which show no disposition to heal, their use may some- times be followed by good effects, on the same principle that they were hurtful in the preceding case ; if they should not cause a suffi- cient degree of excitement, they may be smeared with some stimu- lating ointment. In extensive collections, in wThich the matter is not sufficiently evacuated by the external aperture, injections are by some recommended, and, perhaps, occasionally employed : in those ab- scesses which are comparatively recent, and in which the surround- * [Throughout the Elements, the edition of Practical Surgery referred to is that of 1842. Philadelphia.]
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