In the treatment of large indolent collections, it was proposed by
Mr. Abernethy to make a small and indirect aperture, and to evacuate
the contents of the abscess as often as the matter accumulated; but a
degree of constitutional irritation frequently supervenes upon this
proceeding, and the discharge becomes bloody, putrid, and mixed with a
considerable quantity of gaseous fluid. The discharge of blood probably
arises from the usual support being taken away from the vessels
ramifying on the surface of the cavity, in the same way that blood is
effused into the cavity of the abdomen, in consequence of the too rapid
evacuation of the serum in ascites.
Suppuration, more especially when extensive and long continued,
is attended with a peculiar species of fever, termed Hectic. This
fever is the remote consequence of local injury, or disease, whereas
symptomatic inflammatory fever is the immediate one. The incessant and
long-continued addition of pus to the blood may be the cause of hectic
fever. In cases of pulmonary consumption, pus globules are almost
uniformly detected in the blood. This fact has been noticed by Dr. Davy
and Mr. Gulliver. The pus is probably carried along the capillaries,
where it is always forming in chronic abscesses: in short, all the pus
formed is not separated from the blood. Hectic probably arises from
the never-ceasing addition of a little pus to the blood, inflammatory
fever from the sudden addition of a large quantity. In long-continued
disease, particularly internal, the hectic occasionally occurs before
the existence of suppuration is indicated; and it does not always
supervene upon suppuration, even though extensive. Hectic has been
supposed to arise from the absorption of pus; but pus cannot well be
absorbed without disintegration of its particles (and then it would
be no longer pus), for their diameter exceeds that of the more minute
bloodvessels and absorbents. Abscesses occasionally disappear, without
this event being followed by any unpleasant symptom.
Hectic fever is most apt to arise in constitutions originally weak; and
usually either from some incurable disease of a vital organ, or from
extensive affection of a part not essential to life; but it may also be
induced without any local assignable cause.
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