The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
Cold abscesses have not only a significance of their own, but for the
most part an identity. Their distinguishing feature is a _limiting
membrane_, which forms whenever sufficient time has elapsed. Much has
been written about it, and much error has been perpetuated with regard
to it. This is the membrane formerly considered and called _pyogenic_,
under the misapprehension that by it the pus or contents of the abscess
were produced. I desire to emphasize in every possible way that this is
a mistake. This membrane does not act to produce pus, but is rather the
result of condensation of cells around the margin of the tuberculous
lesion, forming, as it were, a sanitary cordon, for the absolute and
definite purpose of protection against further ravages. I would suggest
that the term pyogenic membrane be abolished, there being no such
membrane under any circumstances, and that, this be known as that which
in effect it is--namely, a _pyophylactic membrane_. _It is a protection
against pus_, and were it not for its presence there would be no limit
to the spread of tuberculous invasion. A lesion thus surrounded is
shut off from most possibilities of harm, rarely encroaches, except
by the most gradual processes, and, on the contrary, often contracts
and reduces its dimensions, the watery portion of its contents being
gradually absorbed and the more solid and cellular portions becoming
condensed into matter which undergoes caseous degeneration, so that
eventually recovery may ensue as the consequence of a metamorphosis of
an original cold abscess into a caseous nodule surrounded by the old
pyophylactic membrane, which is now serving as a capsule.
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