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ABSCESSES, ACUTE AND COLD
How They May Occur and How to Treat Them
Two kinds of abscess are here described-the acute and the chronic or"cold" abscess, the latter being always quite different in character from the former. The reader should consult such other headings: SEE Bacteria; Boil; Breast; Carbuncle; Fistula; Inflammation; Pyaemia; Septicemia; Tuberculosis; Whitlow.
 
The occurrence of inflammation in the tissues and organs of the body may result in an acute abscess, which is a collection of pus or matter surrounded by a layer of new-formed tissue known as the abscess wall. This is formed by the body in order to limit the extent of the abscess. Pus (q.v.) consists of a liquid derived from the blood and from the liquefaction of tissue which has been killed in the inflammatory process and in which are suspended white blood cells, here called pus corpuscles.
 
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Smokh   WHITLOW: VARIOUS DEGREES
1. Pus quite superficial. 2. Abscess pressing on a nerve and causing acute pain. 3. Abscess opening into and infecting the tendon sheath. 4. Connexion of tendon sheaths wiih the large; sheath at the wrist.
The contents of an abscess are under pressure, more or less, and tend to move forward, usually towards the skin or outer surface, but sometimes the pus burrows between muscles.
The symptoms of an abscess begin with those of inflammation, and when this happens near the surface of the skin a part becomes red and swollen. Pain will be felt, and when touched the part will be found hot and tender. These signs will increase and, if the abscess is of any size, the part will feel hard and brawny. Later it becomes elastic towards the centre of the area, and a trained finger will feel the presence of fluid.
Symptoms of Inflammation and Fever - The development of an abscess is attended by general symptoms of more or less severity. The patient is fevered, and he may suffer from a rigor. This means that he is first seized with a sense of chill, perhaps to such an extent that his teeth actually chatter. Then he feels hot and, lastly, breaks into a sweat and his tem perature falls. The pus creeps towards some spot on the skin where it is said to"point," and which is perhaps indicated by a deeper redness and greater tenderness; the skin then gives way and the pus gushes out, bring ing, as a rule, much relief from local and general discomfort. For a number of days matter continues to come away, but in favour able cases it becomes thinner and the abscess cavity shrinks and heals, its place being taken by scar tissue.
If treatment directed to the inflammation is carried out at once, possibly an abscess will be averted. The main thing in this connexion is rest. If this can only be secured by the patient going to bed he should do so. If the upper limb is affected it may be rested by putting it in a sling, and sometimes a splint is in dicated as well. The hand, if the mischief is there, should be well raised in the sling, and, in the case of the foot, a pillow should be placed beneath it. Cold applications are sometimes soothing; at other times heat is more so, and may be applied in the form of fomentations poultices.
If an abscess is forming, heat may be continued, as it helps to bring the abscess to a head; but an abscess should not be allowed to burst into a poultice, nor should the poultices be continued when this has occurred.
It is not a good policy; however, to leave an abscess till it bursts. Apart from the continuance of suffering, there is some danger of blood poisoning.
The abscess should, therefore, be opened by a doctor at the appropriate time, after which it is dressed antiseptically once or oftener each day, a common dressing being cyanide gauze lightly wrung out of 1 in 40 carbolic acid solution and bandaged over cotton wool.
An acute abscess may occur in any part of the body, but wherever it occurs the foregoing description is more or less applicable. There are, however, peculiarities shown by abscesses in particular situations. If for any reason pus has difficulty in making its way to the surface within or without the body, certain things will happen. Pain is likely to be severe, and there is a greater absorption of poisonous substances into the blood with a corresponding increase in the severity of the constitutional symptoms - fever, delirium, and so on.
This difficulty in the way of the pus is found in abscesses in the ear, under the palmar fascia of the hand and plantar fascia of the sole of the foot, in the deep tissues of the finger, where an abscess is popularly called a whitlow (q.v.), and in other situations.
A boil and a carbuncle resemble an ordinary abscess in some ways, but they differ in that each contains a piece of tissue which has died, or, as doctors say, sloughed-a small portion in the case of a boil, but possibly of considerable size in a carbuncle. The result of this is that when the pus discharges from the opening at its top, in the case of a boil, or from several openings in a carbuncle, there is not the imme diate alleviation of symptoms that ordinarily follows the bursting or opening of an abscess.
The blood poisoning which accompanies an abscess usually consists of the absorption into the blood of substances manufactured by the organisms causing the abscess.
Sometimes, however, the organisms themselves make their way into the blood stream, a state of affairs described as septicemia; and at other times the pus gets also into the blood. This is called pyaemia, and one effect of it is the occur rence of what are called metastatic or pyaemic abscesses. The pus passing along in the arteries reaches those of small calibre through which it is unable to make its way. Wherever it thus becomes held up a fresh abscess may form, and there may be many such all over the body. It is not the pus cells which do this, but the microbes which accompany them; sometimes it is a tiny mass of blood clot or thrombus, carrying bacteria, which causes the fresh abscess. Whether it a mass of blood clot or of pus, it is known as an infective embolus (q.v.).
A quinsy is an abscess in the loose tissue which surrounds a tonsil. While the matter is collecting there is marked swelling in the neighbouring parts, so that speaking, swallowing and perhaps breathing become difficult and painful. The same difficulties are found in a retro-pharyngeal abscess (q.v.), that is, one behind the lining of the back of the throat.
A milk abscess is one occurring in the breast of a nursing mother. It is due, not to the accumulation of milk, but to the introduction of microbes into the breast, usually through cracks or abrasions of the nipple. It is thus necessary to exercise the most scrupulous cleanliness of the nipples before and after suckling. Should the delicate skin of the nipple become sore and raw, or cracked, a breast glass should be used and friar's balsam applied to the nipple until it heals (See Breast).
The tropical abscess of the liver (q.v.) differs from an ordinary abscess in that it is not due to bacteria, which are vegetable in their nature, but to a minute animal, an amoeba.
Cold Abscess: - What is called a cold, o chronic, abscess is almost always due to the microbe of tuberculosis, and is a condition usually found in connexion with bones, joints or glands. It is cold because it is not accompanied by the signs of inflammation. It is called an abscess because it consists of fluid with a superficial resemblance to pus, which again has a limiting wall. But the fluid is not pus; it consists of liquefied dead tissue which has undergone fatty degeneration.
An abscess of this kind is usually painless unless it presses on nerves. It also tends to make way for itself, and, owing to the influence of gravity, may extend far from its original source. When a cold abscess reaches and is undermining the skin there may be redness to mark the place. Such an abscess should never be allowed to burst, as there is an imminent danger that the abscess cavity will be invaded by the microbes which cause acute abscesses.
This exposes the patient to a long continued suppuration which may give rise to fever and deplete his strength, and which often enough proves fatal.
A form of degeneration of tissue known as amyloid disease is often one of the consequences of prolonged suppuration of this kind. It affects liver, kidneys, bowels, and other parts.
The treatment of a cold abscess is that appropriate to tuberculosis and described under that heading, viz. rest, fresh air, sunlight, generous dieting and so on, together with such surgical interference as may be called for
Smokh   Tuberculous Abscess

The caseation of tuberculous granulation tissue and its liquefaction is a slow and insidious process, and is unattended with the classical signs of inflammation—hence the terms “cold” and “chronic” applied to the tuberculous abscess.
In a cold abscess, such as that which results from tuberculous disease of the vertebræ, the clinical appearances are those of a soft, fluid swelling without heat, redness, pain, or fever. When toxic symptoms are present, they are usually due to a mixed infection.

A tuberculous abscess results from the disintegration and liquefaction of tuberculous granulation tissue which has undergone caseation. Fluid and cells from the adjacent blood vessels exude into the cavity, and lead to variations in the character of its contents. In some cases the contents consist of a clear amber-coloured fluid, in which are suspended fragments of caseated tissue; in others, of a white material like cream-cheese. From the addition of a sufficient number of leucocytes, the contents may resemble the pus of an ordinary abscess.
 
ABSCESS: In Animals - In veterinary practice, when the extension of the abscess is rapid it is said to be a hot or acute abscess, when slow it is cold or chronic. An abscess may occur anywhere, and is known as super ficial or deep according to its situation.
An animal may have a predisposition to abscesses. The horse is most commonly affected, but that may be only because he is more exposed to the conditions favourable to abscess formation, such as abrasions and con tusions of the poll, withers, buttocks and lower extremities of the limbs.
Suppuration of the glands of the throat is present in strangles. In cows, the udders and parotid regions are usual sites. In the dog and cat, abscesses are found in any part of the body and generally follow a bite or wound.
The abscess commences with the infection of the wound with pyogenic micro-organisms. In the acute abscess there is heat, pain, redness and swelling. These symptoms are due to the increased amount of blood which comes to the part. It throws into the abscess a large amount of lymphatic elements, and these with the cells attacked and destroyed constitute the pus. When the abscess is diagnosed the part should be bathed at frequent intervals with hot antiseptics. Between the applications a warm, moist dressing should be placed on the site. The heat softens and attracts to the surface the pus, and there generally appears a point at which the abscess will eventually burst. This may be helped by an incision of the overlying tissue, allowing the contents of the abscess to escape.
An abscess in animals must never be opened before it shows signs of pointing, as more harm than good will result.
The cavity must be thoroughly cleaned and it may be necessary to syringe or wash it out with sterile solutions. If the suppuration has been deep, the wound must be kept open to allow proper drainage. The wound may be painted with tincture of iodine and a clean dressing applied. The cavity should always be allowed to fill up from underneath, and the surrounding tissues must be kept clean and sterile.
 
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