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Subcutaneous Tissue

skin, infection, child, pus, incisions and children

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SUBCUTANEOUS TISSUE Infections of the skin, especially of the tender skin of the newborn or the infant, cause troublesome and extremely malignant affections.

(a) abscess, Phlegman. (Calaway, vol. is gene rally the Staphylococeus pyogenes aureus that invades the skin and there causes necrosis of tissue either through the action of its virus or through interference with the nutrition. The invaded area is marked off by inflammation and the formation of pus, then partly breaks down and is finally eliminated through an opening in the thinned and ischTmic skin. Numberless germs in the pus flood the surrounding skin, where they find easy entrance, as they are now much more virulent because of their former residence in the human body.

It has not yet been determined how much of a role in this process is played by digestive disturbances or general infections, but we can easily understand that atrophic and badly nourished infants offer less resistance than strong and healthy ones, without our trying to explain this by the aid of other facts (intestinal infection).

Several furuncles or subcutaneous abscesses will run together and in their progress undermine the whole skin, lifting it off the subjacent fasciT, often perforating in many places. On the skin of the back in infants we frequently observe these progressive processes.

The formation of furuneles usually starts from regions where the skin is most subject to injury, where it is chafed by the clothing and macerated by perspiration.

We differentiate between the sebaceous furl ncle absce dens) and the cellular luruncle, which latter is very close to an abscess, according to the origin of the furunculosis from a folliculitis or from the tissues themselves (Galen-sky). In infants the furunculosis starts, as a rule, either on the back, on the occiput or the buttocks and it spreads from here over the body, while in older children those regions are more often affected which are mostly subject to injuries like the hands and feet and the nape of the neck (collar-abscesses). The deeper the seat of

infection and the more extensive, the closer it will resemble an abscess or phlegmon, which, however, 'do not differ materially.

The general symptoms increase with the size of the infected area. The prognosis depends, naturally, largely upon the extent of the infection and upon the age of the child and its power of resistance. Even weakly children will survive a staphylococeus-furunculosis, while a streptococcus-phleginon in an infant will spread rapidly like an erisypelas and lead to a speedy death (sepsis). The result of an umbilical infection is similar, owing to the wide obsolete veins which favor its spreading through the system. But even smaller furuneles and subcutaneous abscesses may lead through a combination of unfavorable circumstances to a general systemic infection or at least to a spreading of the to other organs.

Treatment.—This should always be adapted to and limited by the condition of the child. Just as it may be unsurgical to treat an extensive pffiegmon in an adult with small punctate incisions, so it would be a mistake to treat abscesses and furuncles with "wide and sufficient" incisions or to lower the child's vitality through frequent painful packing. In the furunculosis of children we have to evacuate the pus through small punctate incisions without irritating the adjacent skin by strong antiseptics, but we must cover it before the operation with an indifferent salve through which we open the furuncle and then aspirate the pus with a small suction cup (Klapp). We must daily empty every newly-formed furuncle in this manner or those that have refilled. We also give the child a warm bath to which enough potassium permanganate has been added to make the water pink.

Otherwise we protect the skin as much as possible and wrap the child up warmly. All energetic interference is dangerous either because of the considerable loss of blood or because of opening new avenues for infection.

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