The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
Ordinary judgment should be exercised in evacuating every abscess, in
order that opening be made at that point which in the common position
of the body shall be most favorable to drainage by mere gravity alone.
If circumstances compel opening when advantage cannot be taken of
gravity, then one or more _counteropenings_ should be made at points
selected where drainage may be best effected, and where anatomical
conditions do not make it injudicious to incise. Drainage should be
favored by the introduction of a drainage tube or of other aids, such
as gauze, strands of catgut, bundles of horse-hair, etc. Finally, a
dressing should be applied which is both protective and absorbent, and
in quantity sufficient to make compression of the walls of the abscess
cavity--not sufficient to obstruct drainage, but enough to favor prompt
adhesion of surfaces, which by speedy granulation shall ensure prompt
healing.
Abscesses are found in proximity to large vessels or dangerous
anatomical regions, when care must be exercised in opening them. Here
careful dissection should be made under an anesthetic. This is true of
abscesses in the neck and of those around the appendix, for example,
where the general peritoneal cavity is shut off only by more or less
delicate adhesions, and where the surgeon must literally feel his
way with great precaution lest adhesions be torn and the previously
protected cavity infected. At other times, especially in abdominal
abscesses, it is necessary to pack sponges or absorbent gauze in and
about the parts, so that any fluid which may escape may be absorbed by
these dressings.
=Accompanying Disturbances.=--The disturbance of function which
accompanies all congestion and exudation, whether provoked by specific
irritants or not, has been alluded to; but in cases of surgical
infections, especially those which produce local suppuration,
disturbance of function is much greater, while there are other
disturbances which sometimes constitute the worst feature of these
cases. The _presence of pus_ is often indicated, especially when
deeply seated, by one or more _chills_, and the occurrence of a chill
is always marked to varying degree by _pyrexia_. It is conceded that
the chill is an expression of a general septic disturbance; but it
is necessary also not to forget that general septic disturbance is a
frequent accompaniment of pus which is not evacuated as soon as formed.
Moreover in certain cases suppuration and septic infection seem to
occur synchronously, one being local, the other general.
Pus may also be suspected beneath a surface which is red, tender,
swollen, edematous, and pitting on pressure. When fluctuation is added
to these indications any element of doubt is thereby dissipated.
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