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A man of twenty was pricked in the ear by a needle entering the meatus. He uttered a cry, fell senseless, and so continued until the fourth day when he died. The whole auditory meatus was destroyed by suppuration. Gamgee tells of a constable who was stabbed in the left ear, severing the middle meningeal artery, death ensuing.
Since then, the inflammation and sloughing of the part has been attended with a copious suppuration, great loss of substance, extreme debility and emaciation. From this, I am convinced that the ball has shattered and deadened the bone, and now lies impacted in the medullary canal. In fact, there can be no doubt that the wound is incurable, and that amputation is the only resource.
In cases of thickening of the bone with persistent and severe pain, if relief is not afforded by the repeated application of blisters, the thickened periosteum should be incised, and the bone opened up with the chisel or trephine. In cases attended with suppuration, the swelling is incised and drained, and if there is a sequestrum, it must be removed.
The joint is held rigid in the flexed position, and the least attempt at movement causes severe pain; the slightest jar even the shaking of the bed may cause agony. The joint is hot, tensely distended, and there may be œdema of the peri-articular tissues or of the limb as a whole. If the pus perforates the joint capsule, there are signs of abscess or of diffuse suppuration in the cellular tissue.
Streptococci invade the lymph spaces, and are associated with acute spreading conditions such as phlegmonous or erysipelatous inflammations and suppurations, lymphangitis and suppuration in lymph glands, and inflammation of serous and synovial membranes, also with a form of pneumonia which is prone to follow on severe operations in the mouth and throat.
If suppuration occurs, it is necessary to provide for drainage as soon as it is possible to distinguish the presence of pus. Due regard is given the manner of establishing drainage because of the usual existence of sub-fascial fistulae. In these cases, one avoids injecting solutions of aqueous antiseptics.
1. =Of the Head.= Wounds of the scalp are likely to be followed by erysipelatous inflammation; inflammation of the tendinous structures, with or without suppuration. A severe blow on the vertex may cause fracture of the base of the skull. Injuries of the brain include concussion, compression, wounds, contusion, and inflammation.
The pus may form and collect within a circumscribed area, constituting a localised abscess; or it may infiltrate the tissues over a wide area diffuse suppuration. Any tissue of the body may be the seat of an acute abscess, and there are many routes by which the bacteria may gain access to the affected area.
"Go on, Phyllie, tell more," he would groan as I stopped for breath and on I would go piling inflammation on suppuration. Finally, after what seemed an age, the doctor drew a long sigh and looked up at me with a kindly expression that I knew meant "saved."
The prognosis in acute pyæmia is much less hopeless than it once was, a considerable proportion of the patients recovering. In acute cases the disease proves fatal in ten days or a fortnight, death being due to toxæmia. Chronic cases often run a long course, lasting for weeks or even months, and prove fatal from exhaustion and waxy disease following on prolonged suppuration. Treatment.
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