Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • John Eric Erichsen
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

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

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    must be let out early ; as also, when it presses upon raucous canals or impor- tant organs, as on the urethra or trachea, or when it is dependent on the infiltration of an irritant fluid into a part, as in urinary extravasation, it must be evacuated without .delay. The pus should be let out before the skin cover- ing it is thinned, especially when the abscess is situated in the neck or in any other part where it is desirable that there should be as little scarring as possible. In Chronic Abscess, the rule of Surgery is not so explicit. A large chronic abscess often comes on without pain and without serious constitutional disturbance, and may cause the patient no material inconvenience for a con- siderable time. If such an abscess, however, be opened without proper pre- cautions to prevent putrefaction of the discharges, the most serious and even fatal constitutional disturbance may follow. Hence before antiseptics were used as they are now, it not uncommonly happened that a patient carried a chronic abscess unopened, without any very serious inconvenience, for many months or even years, but when it was opened he died in a few days. In such cases death occurred from poisoning by the chemical products of putrefaction —septic poisoning. The fear of this accident deterred Surgeons from apply- ing the rule of early opening to chronic abscesses, and it was formerly the custom to leave them unopened until the skin covering them threatened to give vs^ay. At the present time chronic abscesses are usually opened, or at any rate their contents removed by aspiration or other means, as soon as the presence of pus is recognised. If, however, the abscess be very deeply situated, requir- ing an extensive operation to reach it, it is sometimes advisable to wait until it advances to a more convenient situation before opening it. There are two methods by which the pus may be removed from an abscess— hicision and Tapping with an aspirator or trochar. Treatment of Acute Abscesses.—Incision is practically the only mode of treatment applicable to acute abscesses. Aspiration is so rarely successful, that, save under very exceptional circumstances, it should never be resorted to. The most careful antiseptic precautions should be taken even when opening a small abscess. If the discharges be allowed to putrefy after the cavity is opened, healing is delayed, and unless the opening be very free, the putrid discharges may lead to a return, or even an extension, of the suppuration with severe constitutional disturbance, and ]iossibly general infection. It would at first sight seem of little importance whether organisms were admitted from without or not, as in acute abscesses they are always present before the opening is made. But observation has shown that the micrococci of abscesses soon disappear from the discharges if some efficient antiseptic dressing be applied. It is probable that the opening of the abscess, by relieving the surrounding tissues from tension, allows them to recover their vitality, and if at the same time the cavity be thoroughly drained, the conditions become unfavourable for the growth of the organisms. If from any cause antiseptics are not available, the risk of serious septic poisoning or other trouble may in most cases be avoided by free incisions or large drainage-tubes, for it must not be forgotten that if the cavity can be perfectly drained nothing will be left in it to putrefy. To open an abscess imperfectly, and to allow the contents of the cavity to decom]iosG, will only aggravate the condition of the patient. Before opening an abscess, the part should, if possible, be thoroughly cleaned witli hot soap and water and wrapped for half an hour in a wet towel wrung