the older surgeons, in order to evacuate the matter and give relief to
the patient; or else to continue the application of the caustic for an
inordinate space of time, which is a practice altogether unnecessary,
extremely cruel, and productive of much irritation, constitutional as
well as local.
A too common result of abscess, when inertly treated, is the formation
of a _Sinus_; that is, a canal, the circumference of which is condensed
by deposited lymph, and which furnishes a discharge of unhealthy
purulent matter, frequently thin and gleety. Several sinuses frequently
unite, and evacuate their contents by one opening. Previously to
treating a sinus, its extent must be carefully examined by the probe;
this requires considerable caution, for the full extent of the canal
may not be discovered, in consequence of its tortuous course, or
from its diverging into collateral branches; or the probe, by being
used too forcibly, may pass into parts altogether unconnected with
the morbid cavity. Thus, in exploring a sinus at the lower part of
the leg, or in the foot, the probe may be pushed to a considerable
extent beneath the tendinous sheaths of the muscles, and induce the
surgeon to adopt treatment unnecessarily severe. In the treatment,
we may at first employ setons, injections, and graduated pressure,
as formerly explained; and if these fail, the canal must be freely
laid open by the knife—a mode of practice much more effectual; then
there is formed a cavity similar to that of a recent abscess, and to
be treated accordingly. Incision is most frequently necessary when
the sinus exists in adipose substance, in tendinous structure, in
parts possessed of little vitality, and in patients of a sluggish and
enfeebled constitution. In sinus, as well as in chronic abscess, the
potass is of essential service; a stick of it may be introduced into
the canal, and if the sinus is superficial, the integuments may be
divided by this caustic as effectually as by the knife. The indolent
and callous surface of the sore is thereby destroyed, and the effects
are similar to those which have been already mentioned, when speaking
of the use of potass in abscess; in fact, by its application the sinus
is transformed into an acute and open abscess. Foreign bodies, such as
diseased and dead portions of bones, must be early removed; for it is
to be remembered that these are much more frequently the cause than the
consequence of suppuration.
The healing of an abscess which has been opened closely resembles the
process of union by the second intention in a flesh wound; granulations
arise, attended by the secretion of pus, the cavity gradually
contracts; the surrounding effusion is absorbed along with a portion of
the adipose matter; and on the granulations reaching the surface, new
skin is formed, and the parts coalesce.
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