feel sure that, if I had resorted to ordinary dressing when the
pus first appeared, the progress of the case would have been
exceedingly different.
The next class of cases to which I have applied the antiseptic
treatment is that of abscesses. Here also the results have been
extremely satisfactory, and in beautiful harmony with the
pathological principles indicated above. The pyogenic membrane,
like the granulations of a sore, which it resembles in nature,
forms pus, not from any inherent disposition to do so, but only
because it is subjected to some preternatural stimulation. In an
ordinary abscess, whether acute or chronic, before it is opened
the stimulus which maintains the suppuration is derived from the
presence of pus pent up within the cavity. When a free opening is
made in the ordinary way, this stimulus is got rid of, but the
atmosphere gaining access to the contents, the potent stimulus of
decomposition comes into operation, and pus is generated in
greater abundance than before. But when the evacuation is
effected on the antiseptic principle, the pyogenic membrane,
freed from the influence of the former stimulus without the
substitution of a new one, ceases to suppurate (like the
granulations of a sore under metallic dressing), furnishing
merely a trifling amount of clear serum, and, whether the opening
be dependent or not, rapidly contracts and coalesces. At the same
time any constitutional symptoms previously occasioned by the
accumulation of the matter are got rid of without the slightest
risk of the irritative fever or hectic hitherto so justly dreaded
in dealing with large abscesses.
In order that the treatment may be satisfactory, the abscess must
be seen before it is opened. Then, except in very rare and
peculiar cases [Footnote: As an instance of one of these
exceptional cases, I may mention that of an abscess in the
vicinity of the colon, and afterwords proved by post-mortem
examination to have once communicated with it. Here the pus was
extremely offensive when evacuated, and exhibited vibros under
the microscope.], there are no septic organisms in the contents,
so that it is needless to introduce carbolic acid into the
interior. Indeed, such a procedure would be objectionable, as it
would stimulate the pyogenic membrane to unnecessary suppuration.
All that is requisite is to guard against the introduction of
living atmospheric germs from without, at the same time that free
opportunity is afforded for the escape of the discharge from
within.
Public-domain text, read in full here on John Shaqi.
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