486 TREATMENT OF SHOULDER ABSCESS. 



which are too small to attract attention. Schimmel urges that the 

 cocci proceed from the lower portions of the limbs by the lymphatic- 

 vessels ; and in support of this view adduces the case of a horse 

 which suffered from a suppurating sandcrack, from which discharge 

 of pus was prevented by applying a bandage, when abscess on the 

 shoulder was shortly developed. 



In most, if not all cases, the infective agent induces suppurative 

 inflammation of the mastoido-humeralis muscle, and sometimes 

 the prescapular and prepectoral lymphatic glands are also in- 

 volved. 



In many of Holler's cases the disease has started in the prepectoral 

 glands, and shown the character of a lymphadenitis chronica sup- 

 purativa. The process either arises in the common mastoido- 

 humeralis muscle, and is of the nature of a suppurative myositis, 

 or the underlying lymph glands are the primary seat of disease, and 

 in such cases it should be described as lymphadenitis suppurativa ; 

 while from this, the inflammation extending to the muscles produces 

 a chronic suppurative myositis. Other growths, however, occur 

 here ; thus in a grey horse Moller saw a melano-sarcoma, which 

 had been mistaken for abscess on the shoulder, and Giinther reports 

 a similar case. The slow development of melano-sarcoma, however, 

 sufficiently differentiates it from the condition now in question. 

 The disease is usually chronic, especially when not treated. Diagnosis 

 seldom offers much difficulty. Shoulder abscess may be distinguished 

 from true tumour by being more rapidly formed, and less sharply- 

 defined, and by the inflammatory character of the swelling. 



Prognosis is favourable where treatment is early adopted. When 

 delayed, inflammation becomes chronic, firm masses of connective 

 tissue are produced, and when these have existed for months com- 

 plete extirpation, which is always difficult, is the only remedy ; 

 otherwise the swelling is again bruised by the collar and becomes 

 inflamed, leading to further formation of fibrous tissue. Whatever 

 the cause, the earlier the abscess is opened and drained, the more 

 rapid and thorough is resolution. Extirpation of the glands is the 

 only means of dealing with chronic lymphadenitis. 



Treatment. Formerly blisters were recommended as the first 

 application, and the abscess was punctured in eight to ten days. 

 Stockfleth inserted the actual cautery into the cavity of the abscess 

 after dividing the skin. Others allow the abscess to mature. Block 

 has recommended the following compound : Ungt. cantharid. off., 

 :{<> parts ; tinct. cantharid. and tinct. euphorb., of each 15 parts 

 (evaporated to half their bulk) ; ol. croton. 120 ; hydrarg. biniod., 



