kept up in consequence of continuing the poultice. The opening will
enlarge, the skin become undermined, loose, and flabby, the abscess
will extend, while the process of granulation may be in a great measure
suspended. In many cases, the poulticing cannot be continued until an
opening has formed naturally, and the cure is often much accelerated by
the artificial evacuation of the matter. When the abscess is situated
deeply, or beneath a fascia, a free and early opening must be made.
For example, when suppuration has occurred in the cellular tissue
beneath the fascia lata of the thigh, it at first naturally tends
towards the surface, but its progress is impeded by the tendinous
aponeurosis; a painful feeling of tension is thereby occasioned, and
the matter extends where there is least resistance, making its way in
all directions into the surrounding cellular tissue—separating the
muscles—isolating the arterial trunks—burrowing beneath the fascia
over the whole limb, and producing most serious, and often irreparable
mischief, with violent constitutional disturbance. The bad effects of
delay are again daily witnessed in neglected cases of paronychia; most
excruciating pain is produced—the system is seriously affected—the
tendons slough, and the member is rendered useless.
By the continued presence of purulent matter, absorption, ulceration,
caries, and even death, of bone, is frequently produced, all which
might have been prevented by its evacuation. If pus collect in the
neighbourhood of cavities or canals, it is of the utmost importance
that it be early discharged; and the evil effects of negligent and
dilatory treatment are well exemplified in the following cases:—A
patient had been allowed to suffer, for a long time, under an extensive
abscess at the lower part of the neck, beneath the origins of the
sterno-mastoid muscles. The abscess at length gave way externally; but
the patient was at the same time seized with profuse expectoration
of pus, and during expiration the air escaped through the external
openings in the neck. It was evident that the abscess communicated with
the trachea, and it also appeared to have extended deeply into the
mediastinum. The patient soon perished, but there was no opportunity
of examining the parts. In another case of extensive abscess at the
root of the neck, an opening was proposed, but delayed. At length, the
abscess gave way spontaneously; and from the circumstance of portions
of solid as well as fluid ingesta escaping by the external opening,
it was evident that the œsophagus had ulcerated. The cure was very
tedious, but ultimately complete, and apparently much accelerated by
free counter openings.
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