A manual of the practice of surgery / by W. Fairlie Clarke.
- Clarke, W. Fairlie (William Fairlie), 1833-1884.
- Date:
- 1879
Licence: Public Domain Mark
Credit: A manual of the practice of surgery / by W. Fairlie Clarke. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![preaches the surface it becomes puiiiful, involves the skin, ulcerates, and ctiscliarges itself. Sometimes the inflammation which precedes suppuration is so slitrht, or so slow in its progress, that it excites no uneasiness, until a swelling is detected containing pus. Such, at least, would seem to be the pathol- ogy of cold abscesses. What circumstances conduce to suppuration ? How comes it that in one case inflammation gives rise to adhesion, while in another it leads to the formation of pus? This seems to depend upon the quality of tlie effused material. In proportion as it is healthy or fibrinous, adhesion is likely to take place; while on the other hand, in proportion as it is un- healthy or corpuscular, it is prone to suppurate. In truth, there is but a step between the exudation-cell and the pus-globule. The quality of the effusion depends in a great degree on the state of the patient's health; when this is good, the character of the effusion will be good also, and vice versd. Again, the seat of the disease influences the nature of the effusion: mucous membranes very readily suppurate; serous membranes but seldom. Again, the access of air seems to promote suppuration. Hence the advantage of a subcutaneous incision to which little or no air is admitted. The treatment of suppuration is partly/oca^ and partly constitutional. Locally, we must try to take away the cause, if it be a foreign body, a piece of dead bone, or anything else that is capable of removal. Such things are often the causes of chronic abscess. Then we must endeavor to reduce the inflammation, by studying the position of the part, and by using cold lotions, water-dressing, fomentations, or poultices, as the case may require. Lastly, we must give a favorable exit to the pus, and do what we can by antiseptic, stimulating or astringent applications, to bring about a more healthy action, and to limit the amount of discharge. An acute abscess should be covered with a poultice made of bread, bran, chamomile flowers or linseed-meal. As soon as fluctuation is de- tected, a sufficient incision should be made to let out the pus, and the poul- tice continued. A chronic abscess will often require to be laid freely open, stuffed with lint, and allowed to heal from the bottom. In the case of a large chronic abscess, connected with disease of the spine, for example, it is best to make a small valvular tJidsion, that is to say, to pass the knife obliquely under the skin for a short distance before it reaches the cavity; or the air-tight syringe, known as the aspirator, may be used. By these means the entrance of air is prevented, while the matter is drawn off, a little at a time, on repeated occasions, so as to allow the walls of the abscess to contract gradually. The older surgeons used to regard suppuration with more favor than we do at the present time. With certain exceptions it is scarcely too much to say that the modern surgeon wishes to prevent altogether the formation of pus, and that the aim of surgery in this respect is to coun- teract the irritating influence of putrefaction, so as to reduce all wounds, as it were, to the condition of subcutaneous injuries. ]\Iany attemi-)ts have been made to effect this object, and various methods of jn-actice have been suggested; but the most successful is undoubtedly that which has been introduced by Professor Lister of Edinburgh. I have had the advantage of witnessing the antiseptic system as it is carried out in his wards, and I cannot doubt its value. I shall, therefore, briefly describe it. Mr. Lister has found no substance so convenient for antiseptic dress-](https://iiif.wellcomecollection.org/image/b21046645_0028.jp2/full/800%2C/0/default.jpg)
