A Sinus is a tortuous track opening usually upon a free surface and leading down into the cavity of an imperfectly healed abscess. A sinus may be an unhealed portion of a wound. Many sinuses may be due to pus, burrowing subcutaneously. A sinus fails to heal because of the presence of some irritant fluid (as saliva, urine) or, because of the existence of some foreign body, as dead bone, a bit of wood, a bullet, a septic ligature, or because of rigidity of the sinus wall, which rigidity will not permit collapse. The walls of a tubercular sinus are lined with a material identical with the pyogenic membrane of a cold abscess. Sinuses may be maintained by want of rest (muscular movements) and by general ill-health.
Treatment. In treating a fistula, remove any foreign body; lay the channel open, curet, touch with pure carbolic acid, and pack with iodoform gauze. In obstinate cases, entirely extirpate the fibrous walls; sew the deeper parts of the wound with buried catgut sutures, and approximate the skin surfaces with interrupted sutures of silkworm gut. Fresh air is necessary; nutritious food and tonics must be ordered.
Acute Abscesses. An abscess may be defined as a circumscribed cavity of new formation, containing pus. An essential part of this definition is the assertion that the pus is in a cavity of new formation; is an abnormal cavity; hence pus in a natural cavity (pleural or synovial) constitutes a purulent effusion, and not an abscess, unless it is encysted in these localities by walls formed of inflammatory tissue.
An acute abscess is due to the deposition and multiplication of pyogenic bacteria in the tissues or in inflammatory exudates.
When abscesses form in an internal organ or in some structure which is not loose like connective tissue, for instance, in a lymphatic gland, a mass of pyogenic bacteria floating in the blood or lymph, lodges, and these bacteria, by means of irritant products, cause coagulation necrosis of the adjacent tissue and inflammatory exudation around it. The area of coagulation necrosis becomes filled with white blood cells, and the dry necrosed part is liquefied by the cocci. Suppuration in dense structures causes considerable masses of tissue to die and to be cast off, and these masses float in the pus.
An abscess heals by the collapse of its walls, and the formation of an abundance of granulation tissue; in many cases granulations of one wall join those of the other side, the entire mass of granulations being converted into fibrous tissue, and this tissue contracting, heals by third intention. If the walls do not collapse, the abscess heals by second intention.
Symptoms. The symptoms of an acute abscess may be divided into (1) local, (2) constitutional. Locally there is intensification of inflammatory signs; swelling enormously increases; the discoloration becomes dusky; the pain becomes throbbing, and the sense of tension increases; the cutaneous surface is seen to be polished and edematous, and after a time, pointing is observed and fluctuation can be detected. The constitutional symptoms are usually limited to chills and fever, depending upon the severity of the infection.
Treatment is free incision and drainage. The wound should be opened early, if possible even before pointing or fluctuation, to prevent destruction, subfascial burrowing, and general contamination; drainage is continued until the discharge becomes scanty, thin and seropurulent.
Chronic Abscess is a term referring only to time. Usually a tubercular abscess is designated as a chronic, cold, or scrofulous abscess. It is an area of disease produced by the action of the tubercular bacilli and is circumscribed by a distinct membrane. The symptoms present no inflammatory signs. Constitutional symptoms are trivial or absent unless secondary infection occurs. The treatment of these cold abscesses depends upon their location.
A Furuncle or Boil is an acute and circumscribed inflammation of the deep layer of the skin and the subcutaneous cellular tissue, following on bacterial infection of the hair follicle through a slight wound (by scratching, shaving), with the staphylococcus pyogenes aureus.