Abscess

“ It is justifiable to infer from the absence of amœbæ from the pus constituting what might be called the body of the abscess, and their appearance in the pus coming from the walls of the abscess a few days later, that the habitat of the parasite is not so much the pus occupying the general abscess cavity as that immediately in contact with the wall and the breaking-down tissues themselves. ”

“ The exact location of an abscess also may furnish a key to its source; in axillary abscess, for example, if the suppuration is in the lymph glands the infection has come through the afferent lymphatics; if in the cellular tissue, it has spread from the neck or chest wall; if in the hair follicles, it is a local infection through the skin. ”

“ This kind of abscess, though not itself dangerous, has given opportunity for the inoculation of venereal matter in the hands of accoucheurs, and of putrid matter from the dissection of diseased bodies; and has thus been the cause of disease and death. When putrid matter has been thus absorbed from a dead body, a livid line from the finger to the swelled gland in the axilla is said to be visible; which shews the inflammation of the absorbent vessel along its whole course to the lymphatic gland; and death has generally been the consequence. ”

“ An abscess may be detected, if situated externally, by heat, pain, redness, and swelling in the early stages, and, if further developed, by the fluctuation which is present. When any of these symptoms are absent, the suppuration should be encouraged by the means of hot fomentations and poultices. Care must be taken that the abscess is not opened too soon, or to some extent it may cause it to scatter, and the escape of pus will be lessened. The time to open an abscess is just before it is ready to break, and should be done with a sharp lance, a crucial incision sometimes being necessary. ”

“ The cure. Our first object, therefore, ought to be to assist [492] the concoction of the abscess, which may be attempted by fomenting with sponges, and applying cataplasms made of barley-flour, with dried figs boiled, some rosin, pigeon’s dung, nitre, and mallows. The rupture of the abscess is promoted by lying upon the side which is not affected. Let them drink at intervals honied water, and the juice of ptisan with honey. Those who are stronger may likewise drink the decoction of hyssop and thyme with honey. ”

“ This process of alternate emptying and refilling of the abscess cavity may recur many times before recovery finally takes place. In some cases it continues for months, and may finally wear out the patient. Abscess may form in the lung ; or a sudden and fatal hæmoptysis may be brought about by ulceration opening some large pulmonary vessel. In some, expectoration never altogether ceases; if accompanied by fever this persistency indicates imperfect drainage, or, possibly, the presence of a second and unruptured abscess. ”

“ Formation of an Abscess.#--When pyogenic bacteria are introduced into the tissue there ensues an inflammatory reaction, which is characterised by dilatation of the blood vessels, exudation of large numbers of leucocytes, and proliferation of connective-tissue cells. These wandering cells soon accumulate round the focus of infection, and form a protective barrier which tends to prevent the spread of the organisms and to restrict their field of action. ”

“ It is the life of the microbe inoculated under the skin which causes the abscess. The abscess, with the membrane which surrounds it, becomes for the little organism a sort of closed vessel, which it is even easy to tap without sacrificing the guinea-pig. The organism is mixed with the pus in a state of great purity, and although it is localised its virulence is extreme. When fowls are inoculated with the contents of the abscess they die rapidly, while the guinea-pig, which has furnished the virus, gets well without the least suffering. ”

“ In all cases of abscess discharging through the lung a careful register should be kept of three things —body temperature, daily amount and character of expectoration, and, once a week, the weight of the patient. If temperature keeps up, if the amount of pus continues the same or increases, or if the patient continues to lose weight, an attempt should be made at all risks to reach and drain the abscess from the outside. ”

“ Many surgeons advise that so long as the abscess is quiescent it should be left alone. All agree, however, that if it shows a tendency to spread, to increase in size, or to approach the skin or a mucous membrane, something should be done to avoid the danger of its bursting and becoming infected with pyogenic organisms. Simple evacuation of the abscess by a hollow needle may suffice, or bismuth or iodoform may be introduced after withdrawal of the contents. ”

“ When the occurrence of rigor, or the development of hectic, or the appearance of local bulging, or the persistency of the fever and of the local symptoms, gives ground for suspecting that abscess has formed, active medication must be suspended, a somewhat improved dietary prescribed, and measures taken without unnecessary delay to locate by means of the aspirator the position of the pus. ”

“ It is seldom advisable to wash out an abscess cavity, and squeezing out the pus is also to be avoided, lest the protective zone be broken down and the infection be diffused into the surrounding tissues.
The importance of taking precautions against further infection in opening an abscess can scarcely be exaggerated, and the rapidity with which healing occurs when the access of fresh bacteria is prevented is in marked contrast to what occurs when such precautions are neglected and further infection is allowed to take place. ”

“ Of course, the surgeon declares that pus should be let out by cutting into it, or it is liable to break into the peritoneal cavity and cause death This is positively not the truth, for when an abscess threatens, nature at once proceeds to throw a wall around in order to avoid accidents. All around the point of prospective abscesses, heavy walls of adhesions are built, and if nature is not interfered with, the abscess will break into the gut, because it is the point of least resistance, and it is also the point favored by gravity. ”

“ The swelling may attain a considerable size without the patient being aware of its existence, and, as a matter of fact, it is often discovered accidentally. The absence of toxæmia is to be associated with the incapacity of the wall of the abscess to permit of absorption; this is shown also by the fact that when even a large quantity of iodoform is inserted into the cavity of the abscess, there are no symptoms of poisoning. The abscess varies in size from a small cherry to a cavity containing several pints of pus. ”

“ An abscess in a lymph gland is usually due to infection passing by way of the lymph channels from the area of skin or mucous membrane drained by them. Abscesses in internal organs, such as the kidney, liver, or brain, usually result from organisms carried in the blood-stream from some focus of infection elsewhere in the body. ”

“ After opening spontaneously, the abscess closes again and heals, while the animal preserves its appetite and its appearance of health. These abscesses sometimes last several weeks. They are surrounded by a pyogenic membrane and filled with a creamy pus, in which the microbe swarms side by side with the pus globules. ”

“ Such abscesses, occurring in the limbs or scrotum, will discharge in due course, or may be opened; if properly treated surgically they may lead to no further trouble. Should they form in the thorax or abdomen, serious consequences and even death may ensue.
Probably, in certain instances, abscess forms at times independently of the death of the parasite; e.g. in varicose glands, in lymph scrotum, in elephantiasis. The death of the parent filaria is apt to be lost sight of as a possible cause of abscess in the subjects of filarial infection. ”

“ Whatever be the vesicant chosen, it is best after three or four days to apply emollients of slightly antiseptic character, such as ointments containing camphor, boric acid, salol, etc. When abscess formation is recognised the abscess should be opened as early as possible. Some precautions are necessary to avoid injuring important nerves and vessels; in dealing with a deep-seated abscess it is necessary to use the knife for dividing the skin alone, to seek the abscess by blunt dissection with the finger or with round-pointed scissors, and to open it with a similar instrument. ”

“ Loose stools often prove critical, and carry off the disease.
If an abscess or imposthume is formed in the liver, all methods should be tried to make it break and discharge itself outwardly, as fomentations, the application of poultices, ripening cataplasms, &c. Sometimes indeed the matter of an abscess comes away in the urine, and sometimes it is discharged by stool, but these are efforts of Nature which no means can promote. When the abscess bursts into the cavity of the abdomen at large, death must ensue ”

“ Chronic rectal abscess corresponds to the cold or chronic abscess in other situations: it is apt to occur among those who are much debilitated or among those of the scrofulous diathesis. These abscesses have little disposition to open spontaneously upon the surface, but they burrow extensively in all other directions—high up along the outside of the rectum, laterally into the tissues of the buttock, or downward and forward into the perineum. The process of formation may occupy many months, and sad havoc may be occasioned before their existence is suspected. ”

“ Active inflammatory action may, however, be excited at any time, as in other chronic abscess, by a new infection, septic organisms entering the abscess by way of the uterine cavity, an adherent loop of intestine, or the bladder. The woman will then have an attack of acute septic inflammation in the old pyosalpinx, and will be exposed to the various dangers that were imminent during the primary acute stages of the disease. ”

“ But suppose you have an abscess on your hand; that abscess is swarming with germs, and the lymph in its passage will carry away a vast number of these injurious microbes, and will take them to the glands of the armpit. The germs remain in the glands and give the glands extra work to do. The glands will enlarge and become inflamed. If the infection of the glands is very virulent, the glands may, as it were, die at their post and become abscesses. Now we can proceed. The commonest cause of inflamed glands in the axilla is inflammation and suppuration about the hand or arm. ”

“ In woman peritonitis following rupture of the womb usually shows streptococcus pyogenes.
e. Rupture of Abscess into the Peritoneum. As an abscess is nearly always the product of pus microbes it follows that its rupture into the abdominal cavity will determine infection. If the abscess contains some special infective germ like that of strangles or glanders the resulting inflammation partakes of their nature.
f. Penetration of Microbes through the Circulation. Healthy blood is free from germs, yet it is not uncommon to find a few circulating in the blood in given conditions. ”

“ The bacteria which produce the various wound infections and abscesses, etc., appear to vary under normal conditions from a type capable of producing violent and fatal blood poisoning to a type producing only a simple abscess, or even to a type that is entirely innocuous. ”

“ In acute cases multiple abscesses in the kidney may give rise to pain and albuminuria, abscesses in the lungs to dyspnoea, while acute peritonitis may arise from rupture of a splenic abscess into the peritoneal cavity, and sudden blindness be the result of the plugging of the arteria central is retinae. The duration of a case of pyaemia depends on the severity of the infection. Death may occur from the formation of abscesses in vital organs such as the brain and heart, or from exhaustion from continued suppuration, or chronic forms may after months pass on to complete recovery. ”

“ When there is reason to expect that an abscess will form in joints, the abscess is carried off by a copious discharge of urine, which is thick, and becomes white, like what begins to form in certain cases of quartan fever, attended with a sense of lassitude. ”

“ Should the pain, however, be extremely acute, and accompanied with throbbing, and other inflammatory symptoms, it will be advisable to resort to blood-letting, and to apply blisters behind the ear, or to the neck. If an abscess be apprehended, warm poultices should be frequently laid on the part affected, before they become cold; and when such abscess breaks, milk and water, or chamomile tea with the tincture of myrrh, must be repeatedly injected by means of a syringe. ”

“ It is inadvisable to explore for a suspected abscess with a hollow needle without first opening the abdomen, as septic fluid might thus be enabled to leak out, and infect the general peritoneal cavity. If an hepatic abscess is injudiciously left to itself it may eventually discharge into the chest, lungs or belly, or it may establish a communication with a piece of intestine. The only safe way for an abscess to evacuate itself is on to the surface of the body. ”

“ It is always necessary to apply strong liniments to the
throat, as they relieve inflammation and stimulate the formation of an
abscess. The following liniment will be found very beneficial: Aqua
Ammonia Fort., four ounces; Oil of Turpentine, four ounces; Sweet Oil,
six ounces; shake well and apply two or three times daily. If the
swelling is extreme between the jaws, so as to interfere with the
animal's breathing, it is well to lance the abscess if a soft spot can
be found. Just cut through the skin with a knife; then use a clean blunt
instrument to locate the pus cavity. ”