The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
Around the margin of the site of an acute abscess a barrier is formed
by condensation and cell infiltration of the surrounding tissues. This
is not a distinct wall nor membrane, yet, nevertheless, serves as a
sanitary cordon to confine the mimic conflict within reasonable bounds.
This is the zone of real inflammation; within it there are tissue
destruction and coagulation necrosis. By virtue of the peptonizing
power of the pyogenic organisms the parts involved in this necrosis
gradually liquefy the intercellular substance dissolving first. It is
this which in the main forms the fluid portion of the pus. Various
tissues show widely differing resistance to this softening process. In
true glands the interlobular septa seem to break down first, and in
this way suppuration extends around the acini or gland lobules, and
thus pus may contain masses of easily recognizable size. These masses
are ordinarily known as _sloughs_.
It is by virtue of the so-called lymphoid cells, which are those
principally involved in producing the barrier or boundary of the
acute abscess as above described, that granulation tissue is formed,
which takes up the effort of repair as soon as pus is evacuated. This
boundary has no sharp limit, but shades off into healthy surrounding
tissues.
Under the term “abscess” is meant that which is described as _acute
abscess_. Under certain circumstances, especially when they are
produced by the facultative pyogenic organisms rather than the
obligate, abscesses form more slowly, and may be spoken of as
_subacute_. These are terms used in contradistinction to the so-called
_cold abscesses_, which, although clinically bearing a certain
resemblance to the acute, are in almost every pathological respect
different from it. Cold abscesses will be considered under the head of
Tuberculosis. It is possible to have an acute pyogenic infection of a
cold abscess; in such case we have acute manifestations. _Gravitation
abscesses_ are those where pus forming in one part tends to migrate,
usually in the direction in which gravity would take it, extending
into portions deeper or lower. Perhaps the best illustration of
this is the pointing of a psoas abscess below Poupart’s ligament.
_Metastatic abscesses_ are those which are formed as the result of
embolic processes, each one being in miniature a repetition of a lesion
which has occurred at some other part of the body. The underlying
fact concerning metastatic abscesses is that the primary process
has occurred in some other portion of the body, whence it has been
distributed as above. These will be considered in the chapter treating
of Pyemia.
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