Squeezing or pressing the furuncles must be absolutely prohibited, because the natural wall is thus easily broken and a general infection may follow. The same may be done by packing larger abscesses because the gauze may easily cause a necrosis of the surrounding tissues.
The treatment of abscesses in children is similar. As soon as the abscess reaches the surface and fluctuates distinctly, under ethyl chloride antesthesia and after first protecting the neighboring skin where it "points," we make an incision and then aspirate the pus, the exami nation of which will show which germ caused the infection. Packing is superfluous and very painful as well; should pus collect again it is an easy matter to reopen the incision with a probe until the core is entirely separated. This is surely less painful than repeated packing. We apply heat to favor the natural hypertemia and to help the inflammation; ice-bags are a mistake, and are permissible only in those eases where the high tension of the tissues causes unbearable pain (tonsillar abscess) or in which we intend to make use of the therapeutic action of retard ing the process (slower absorption of the virus in peritonitis).
This treatment with slight changes will suffice for larger abscesses and phiegmons as well. We aid the reactive inflammation by the appli cation of heat (thermophores, poultices, warm fomentation); we do not make our incision too large, or at least not continuous; we avoid packing and syringing; in short, we refrain from anything which might injure the tissues.
If the discharge of pus should not be sufficiently free owing to the deep location of the abscess cavity (valvular closure of the edges of the wound), we can remedy this easily by the insertion of a permanent drain age tube of either glass or rubber.
Should the focus be on a limb we can use Bier's hyperaemia. We apply a circular elastic bandage as proximal as possible from the focus of infection and thus impede the return flow of blood through the cutaneous veins, while the arterial flow which is located in the centre of the limb is not interfered with, and we thus greatly augment the passive inflamma tory hypertemia and the exudation (inflammatory cedema) (Bier).
The constriction must not compress the pulse and the extremity must remain pink. After from six to twenty hours, according to the condition of the skin, the bandage is removed and the limb elevated, waiting until the cudema has disappeared before reapplying the bandage.
During this treatment the patient must remain in bed, on account of the fever.
(b) Erysipelas (Knopfelmaehcr, vol. i).—This is an infection of the skin which is accompanied by a rapidly increasing redness, swelling, and high fever.
"For its causation are required, first, a highly virulent strain of streptocoeci, and, second, that the lymph spaces in the skin or mucous membrane be infected; the first local symptoms will appear one or two days later" (I.exer). At the point of injury (which cannot always be found, in the nose or in the pharynx) red spots will appear. These have a sharp bonier, marking them from the surrounding skin, and they are slightly elevated; the wall-like border advances rapidly, especially where the skin is loosely attached. This is accompanied by chills and high fever, vomiting and drowsiness, and severe irmlaise; suppuration in subcu taneous tissue may accompany the process in the skin, and we may also observe pus blebs, acute glandular swellings, abscesses, and metastatic suppurations in other organs.
The prognosis is absolutely unfavorable in infants, but it gets better with each year.
The treatment is by no means successful. Mechanical walling off with strips of adhesive plaster has been tried (Wiilifer), but without success. Disinfectants, alcohol compresses, 10 per cent. iehthyol oint ment, only allay the pain. Antistreptocoecus serum does not offer much hope of success, owing to the rapid course of the disease.
Pfaundler (personal communication to the author) has observed excellent results from painting with phenol-camphor twice daily. Judd recommends painting with pure carbolic acid until the skin is white, then washing with alcohol. [Credit should be given for this treatment to the late Seneca Powell.—THE TRANSLATOR.] Treatment should be determined by the patient's general condition and should be symptomatic for the local affection.