If, either from improper management, or the morbid condition of the
action, the abscess, after it bursts spontaneously, or is opened by
art, continue to suppurate, without undergoing the ulcerative action
preparatory to healing, then we find, that either the sides remain
quite separate, producing a cavity, extended more or less, or one
particular portion remains open, forming a sinus. Both of these cases
require a treatment, which, in its principle, is the same, namely, the
indication of the ulcerative action.
In the first case[34], we shall frequently succeed by means of the
seton, especially if we use pressure alongst with it; for, by keeping
the internal surface in close contact, we tend to check the purulent,
or suppurative action, and produce organic particles[35]. We may also
succeed, by using stimulating injections, of such a strength as to
produce a moderate degree of smarting. Of this kind are, wine and
water, solutions of white vitriol, corrosive sublimate, &c. These ought
to be used frequently in the course of the day, and pressure employed
during the intervals. Incision, or laying the part open, is, being the
most severe, the last remedy which is to be had recourse to. Small
chronic abscesses may be laid open during their whole diameter; but
larger ones require only to be cut up for a certain length.
[34] This is exactly similar to an encysted tumor which has been
opened, and requires the same treatment. The internal surface becomes
thick and somewhat hard, like that of a cyst. It differs from an
encysted tumor only in its cause and origin.
[35] If pressure be employed early, to a considerable degree, the
irritation of the means employed produces pain, and a morbid increase
of action, unless we keep down the action by cold, as will be explained
when considering the treatment of ulcers.
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