The formation of matter as a consequence of inflammation of any of the tissues of the body is called an abscess. An abscess may be acute or chronic. An acute abscess may follow an injury such as a blow, or the presence of a foreign body, as shot or a piece of wood, which has been driven into the flesh. A common seat of both acute and chronic abscesses is the lymphatic glands of the neck, groins, or armpits. Following a simple cold, or inflammation of the throat, especially in connection with fevers like scarlatina, the glands in the neck become irritated by absorption of disease-germs from the inflamed surface, and, if the irritation is intense, the tissue are then inflamed and form abscesses. The glands in the groin and armpit may become centres of inflammation or abscess in the same way from cold, over- strain, or injury to the skin of the foot or hand. Another common abscess met with in nursing women is abscess of the breast. Chronic abscesses appear in the same situations, and from the same causes, when there is some constitutional depravity, as scrofula. The commonest and most serious chronic abscesses arise in connection with diseased bones. When the bone of any part becomes diseased, whether the bone of the spine or of any other part of the skeleton, the tissues around are irritated, as they are by the presence of a splinter or foreign body; they consequently become inflamed, and very large abscesses sometimes result.
Diagnosis.-The distinguish features of an acute abscess are swelling, heat, redness, and pain. It is distinguished from other swellings and tumors by the rapidity of its formation, by the throbbing pain and tenderness of the part, and by the constitutional symptoms, especially shivering fits, or “rigors,” as they are called. The formation of an internal abscess may be discovered by the occurrence of these rigors when there is no other apparent cause. When the abscess is large, and has ripened, the sensation of “fluctuation” gives additional certainty. This is obtained by laying the finger on one side of the swelling, and gently tapping the other side; a wave of impulse passes from side to side as when an india rubber bag containing fluid is tapped in the same way. In chronic abscess there is less acute pain, and the formation is more slow, but there are rigors, and fluctuation can generally be obtained. With the constitutional history of the patient there will not be much difficulty in diagnosing the case, and, of course, when the abscess discharges, all doubt is set at rest.
General Treatment.-In the forming stage the part must be given absolute rest. As soon as matter has formed, if the pain is great, warm poultices of linseed or bread may be applied. But when poulticing is resorted to it should always be done with caution. Continuous poulticing renders the parts sodden and of low vitality, making the healing tedious. A much better plan is to bathe the part three or four times a day with hot Calendula lotion (about a teaspoonful of the tincture to the half-pint of hot water); and a compress of the same may be applied with flannel (and not oiled-silk) for a covering. This prepares the tissues for the opening and subsequent healing. if the abscess is superficial I find it much better to let it open of itself than to use the knife. As soon as it has discharged it should be washed from time to time with Calendula lotion and Calendula ointment applied. After the abscess has opened, or has been opened, the compresses should be discontinued, and Calendula lotion applied. Abscesses occurring in special places, as the ear and the breast, require special treatment, which will be described under those headings. The opening of chronic abscesses is attended with considerable danger, and should always be performed by a medical man. The dressing of chronic abscesses requires the service of a skilled nurse for the proper washing out and dressing of the cavity. Calendula lotion (one part of the tincture to ten) is of the greatest service in these cases.
Medicines.-(Every hour when the symptoms are acute until relief is obtained, then less often.)
Mercurius sol. 6.
-So long as there is any chance of stopping the inflammatory process; also for hardness remaining after the abscess has healed.
-When there is much redness, pain, and throbbing with it.
-When matter has formed; this will assist the maturing of the abscess, will sometimes abort it, and in many cases will render opening the abscess unnecessary.
-When discharge has taken place. Profuse discharge in chronic abscess. Silica follows Hepar well; but must not be given immediately after Mercurius.