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Updated: June 9, 2025
However, I discovered no necrosed bone by so doing. Put a tent into this opening, and let the one above heal up, which it did in about two weeks. This latter opening into the joint I kept open by means of tents until the joint became anchilosed and ceased to discharge pus. The patient made a slow and steady recovery, and about the middle of April was able to get out doors again.
Usually they are irregular, nodularly thickened or indurated; sometimes they are raised and crater-like. The floor of the ulcer is smooth and glazed, or occupied by necrosed tissue, and the discharge is watery and blood-stained, and as a result of putrefactive changes may become offensive.
After an interval of from six to ten days a soft white slough is discharged; this is known as the "core," and consists of the necrosed hair follicle or sebaceous gland. After the separation of the core the boil heals rapidly, leaving a small depressed scar.
The first indication is the immediate and complete removal of the infected material. The wound must be freely opened, all blood-clot, discharge, or necrosed tissue removed, and the area disinfected by washing with sterilised salt solution, peroxide of hydrogen, or eusol. Stronger lotions are to be avoided as being likely to depress the tissues, and so interfere with protective phagocytosis.
Why shouldn't the appendix be necrosed? Located in a field of inflammation, blown up, distended beyond its vital integrity; why should it not become gangrenous, It doesn't matter when the perforation of the appendix took place for it is quite evident that there was not enough disease of the appendix to cause its perforation until after it had become encased in the abscess cavity, and if the young man could have been freed from the treatment he received and could have been given the necessary rest the abscess cavity would have emptied itself, necrosed appendix and all, into the bowel and he would have made a perfect recovery.
In the deeply placed cervical glands, especially in cases of streptococcal throat infections, the suppuration rapidly involves the surrounding cellular tissue, and the clinical features are those of an acute cellulitis and deeply seated abscess. When this is incised the necrosed glands may be found lying in the pus, and on bacteriological examination are found to be swarming with streptococci.
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