ANEURISM is the most dangerous con dition to fear. Its less acute history, and the thrill and its expansile pulsation, can only exist in close proximity to a large vessel.
Certain SERISOLID GROWTHS may sim ulate an abscess. When the possibility of an aneurism has been eliminated, a fine trocar or exploring needle, if carefully used, will determine the diagnosis.
Prognosis. — This depends upon the general health of the patient. In the robust a suppurative process usually reaches the stage of resolution without giving rise to complications. In individ uals weakened by disease, hereditary or acquired, an abscess may be protracted and exhaustive, and diffusion is more likely to occur if resisting tissues inter fere with the superficial evacuation of the pus. Deep abscesses are especially prone to become protracted through this cause, the resistance of muscular apo neuroses, etc., forcing the pus into the cellular interstices. Fistulous tracts, or large suppurative areas, are thus created, and the patient may succumb to blood poisoning or asthenia.
Treatment.—General .3Ieasures.—Rest and elevation of the affected region, if possible; salines, if purgation is neces sary. Easily assimilable food, but not low diet; avoidance of stimulating bev erages, alcohol, coffee, etc.
Internal Remedies.—If the case is seen early the suppuration can sometimes be arrested by the use of one of the follow ing agents, supplemented by one of the local applications: Tincture of aconite, 1 to 3 drops every hour, closely watching the patient's pulse; tincture of veratrum virile, 1 drop every hour until the pulse becomes slower, the skin moist, and slight nausea is experienced. Calcium sulphide (sulphurated lime), grain every hour; or I; Sulphate of quinine, 1 grain. Ext. of nux vomica, grain For one pill; to be taken every three hours.
External Remedies. — The surface is carefully cleansed with antiseptic soap and sprayed with a 2-per-cent. carbolic acid solution, or with hydrogen peroxide, every two hours, the atomizer being used for ten minutes at each sitting. O'er Compresses dipped in hot 1 to 4000 corrosive-sublimate solution are very effective.
If the abscess is located upon an ex tremity, a 1 to 4000 corrosive-sublimate solution may be employed in the form of a bath for the limb, the latter being left in the solution several hours at a time.
solution of nitrate of silver (30 grains to the ounce) may be applied frequently with a camel's-hair pencil.
Tincture of iodine may be applied in the same manner every three hours.
When the surface becomes very tender, belladonna ointment may be rubbed in every two hours.
In abscesses characterized by very severe pain a 10-per-cent. solution of cocaine may be introduced by cataphore sis, the anode sponge of a galvanic bat tery being applied to the part. The sittings should last five minutes, and be repeated every three hours, the current not exceeding 5 milliamperes. During the intervals warm fomentations—with borated, camphorated, or pure water— are of great value.
Pads of gauze wrung out of hot boric acid solution (an ounce to a quart of water), applied as hot as the patient can bear them. and well covered with oiled silk to keep in the heat and moisture, are the best; wherever applicable, as with the hands or feet, the inflamed part should preferably be submerged every hour for a period of five to ten minutes in the hot, boric solution itself. James Stuart (N. Y. Med. Jour., Jan. 16, '97).
Surgical Measures. — If suppuration cannot be avoided, the abscess should be opened as soon as an adequate quantity of pus has formed to constitute an ab scess sufficient in size to be recognized by the surgeon as such (Senn), or as soon as the presence of pus has been deter mined by the exploring needle or syringe.
If a local anTsthetic•is necessary, one of the following may be used: Twenty drops of a 1- to 5-per-cent. solution of cocaine introduced subcutaneously near the abscess; ether sprayed over the seat of the abscess until local numbness is experienced; chloride-of-methyl or chlo ride-of-ethyl vapor. The latter is espe cially efficacious; the parts turn white when ready,—generally in about two minutes. Seltzer water_ spurted over the surface may be used to advantage when none of the other agents can be obtained.