To open an ordinary abscess a single small incision suffices; but, if it is large, several small incisions should be made to render perfect evacuation of its con tents possible by drainage. If the ab scess is superficial, the skin alone should be cut, but if it is deep seated the skin and fascia should be incised and the grooved director, or the points of a pair of forceps, used to reach the pus, the opening being kept patent with forceps. The cavity is then thoroughly emptied and syringed out with 1 to 4000 corro sive-sublimate solution until the fluid comes out perfectly clear. Pressure with the fingers is to be avoided. The in cision and its surroundings are then care fully washed with the same solution, and an aseptic drainage-tube inserted. The wound is dusted with iodoform or der matol, and an antiseptic dressing is applied, exerting slight pressure with bandage. If the abscess is deep, the drainage-tube should be shortened daily; if it is superficial, the drainage-tube can be withdrawn the second or third day.
Thirty-two cases of abscess treated by the Otis method: The skin about the affected area is scrubbed with green soap and washed with sulphuric ether and then with bichloride (1 to 1000). A narrow bistoury is then inserted into the abscess-cavity, and the contents gently, but thoroughly, squeezed out; the cavity is irrigated with bichloride (1 to 1000) and immediately filled to moderate dis tension with warm iodoform ointment (10-per-cent. iodoform and vaselin), care being taken not to use a sufficient de gree of heat to liberate free iodine. An ordinary glass gonorrhoeal syringe is used, the plunger being removed, and the barrel warmed in the flame of an alco hol-lamp and filled with ointment by means of a spatula. On finishing the injection, at the instant of withdrawing the syringe from the wound, a compress wet with cold, bichloride solution is applied, which instantly solidifies the ointment at the orifice, preventing the escape of that into the abscess-cavity. A large compress of sterilized gauze is then applied by means of a firm Spica. The patient is told to return in four days, when, if all is well, the dressing is reapplied; but, if any evidence of inflam matory action is found the wound is thoroughly irrigated and cleansed and the injection repeated. It is simple and safe; the patient is not prevented from going about. It leaves no scar. Edwin M. Hasbrouck (N. Y. Med. Jour., June 13, '96).
To postpone active measures until the last moment should be relegated to the past. Best to incise it. Break down all
the divisions between the loculi with the fingers, then rub the walls gently and thoroughly with gauze until the last swab shows no trace of pus or debris. When dressing, distension of the cavity with irrigating fluid should be avoided. Plugging favors the accumulation of blood or serum. In many cases primary union may be obtained by stitching the abscess. If any fluid accumulates, it should be allowed to escape as soon as possible. Pus will not flow upward. Neve (Indian "Med. Jour., Aug. 16, '99).
To prevent stitch abscesses cleanse the skin in the usual way with soap and water, and rub into the skin of the operative field hydrated lanolin oleate of mercury (20 per cent.). A piece of lint smeared with the ointment covers the skin until the second inunc tion, twelve hours later; the lint is then reapplied until the time of operation, when the superfluous ointment is rubbed off with sterile gauze. A. E. Maylard (Annals of Surgery. Jam, 1902).
Cold, or Tuberculous.
Symptoms. — These abscesses fre quently attain a large size, and last for months without their presence being de tected. Besides failing general health, the symptoms of the causative trouble are the only prominent ones. The spine, the hips, the genitourinary tract, and the lymphatic glands are the organs most prone to tuberculous disorders giv ing rise to cold abscesses. They some times appear several months and even years after the beginning of the primary disease.
No pain is experienced, as a rule; cold abscesses are not even tender to the touch. There is no redness until the ab scess is about to break, the focus of the liquid mass being otherwise too deeply seated.
Slight hyperpyrexia is usually present. There is no local heat; hence the name "cold" is given this form of abscess by the Germans, to differentiate it from the "warm" abscess.
The above symptoms are usually fol lowed by the sudden appearance of a swelling. Though generally soft, it may be hard, and suggest a tumor in the vicinity of the spinal column (Pott's dis ease), above or below Poupart's ligament, after burrowing along the psoas muscle (psoas abscess), on the inner aspect of the thigh, or in the lumbar region (lumbar abscess), etc. In the neck cold abscesses are usually due to disease of the neigh boring cervical lymphatic glands. The skin either remains normal or gradually becomes thinned and softened until an external opening is formed.