It sometimes happens, that suppuration takes place very slowly, and
the action seems to be performed with little vigour. In this case,
if the abscess be allowed to burst of itself, we both lose time, and
are often, in the end, disappointed in a cure, the healing process
not taking place. It is therefore useful, in these cases, to have
recourse to other agents besides heat. If the pain be trifling, and
the suppuration be what may be called chronic, or approaching to it,
we will perhaps succeed, by applying gentle pressure on the abscess,
by means of a thin roller, and laying a warm poultice over this. But,
when this fails to increase the action, we ought to pass a seton, by
which we evacuate the matter, and keep up the subsequent action to a
degree sufficient for producing recovery. In doing this, however, it is
necessary to attend to the state of the tumor; because, if, in every
instance, we pass it from the highest to the lowest part, we shall
sometimes make the part give way in a third place. If, for instance,
the abscess be much thinner at the apex than elsewhere, or, if the
action have made considerable progress toward the surface, then the
stimulus of the action increases the performance of the natural process
which was going on, and the action continues to extend itself until
the part gives way. In these cases, then, we ought to pass the seton
from the thin part to the lowest part; and this, in general, will, from
the sympathy of association, be sufficient to excite the action of the
whole internal surface.
When we resolve to use the seton, the following is the easiest method
of introducing it: Make a puncture with a lancet either into the upper,
or the thinnest, and most prominent part of the tumor, according to
circumstances; and, into this puncture, introduce, using the lancet as
a directer, a probe, having a piece of tape passed through its eye.
The lancet is then to be withdrawn, and the probe pushed down to the
under part of the abscess, where its point will be felt under the skin.
A small incision is here to be made upon the knob of the probe, which
is next to be passed through, and the tape drawn after it. The matter
is then to be slowly pressed out; the tape is to be folded; and the
abscess bound up with a compress and roller, so as to make moderate
pressure upon it. Next day, the dressings are to be removed, and a
clean piece of the tape drawn through, after which, pressure is again
to be applied.
The size of the tape, the time which the seton ought to be employed,
and the degree of pressure to be used, must be regulated by
backwardness of the action, and the imperfection of the healing
process.
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