PROCEDURES AGAINST CUTANEOUS HYPERTROPHY 457 



cessive aspirations and applications of the clay poultices will 

 be necessary to effect a cure. 



Note. — The success of this simple operation depends upon 

 absolute repose of the affected area, and upon strict asepsis. 

 If the sac is harshly handled in the operation, or if attempt 

 is made to work the patient with a padded collar, the method 

 is useless, because the sac, stimulated by injury, will refill, 

 become painful and finally will require lancing. 



Hot Abscesses of this superficial variety are analogous 

 conditions with the exception that they develop under the 

 influence of pyogenic infection, — a circumstance which at 

 once suggests entirely different treatment. Small abscesses 

 of this kind will cicatrize promptly after being simply lanced 

 and evacuated, but when the sac is large and a wide zone of 

 skin has been separated from the underlying muscles, healing 

 will be slower than in the serous sac above described. 



TECHNIQUE. — The very best method of encouraging 

 a rapid restoration is to evacuate the contents through a small 

 incision, irrigate the cavity with a weak but clean antiseptic 

 solution and then apply a perforated, soft rubber drainage 

 tube which is retained with a stitch or two at the incision. 

 The tube, which should extend to the uppermost part of the 

 sac, is retained about five days, at the end of which time the 

 abscess cavity will have almost narrowed down to the space 

 occupied by it. Thereafter the pus is squeezed from the tract 

 from above downward twice or three times, until cicatrization 

 is complete. 



Note. — Delayed cicatrization of shoulder abscess is often 

 due to- meddlesome interference, e. g., injections of strong 

 antiseptics and caustics, or packing with oakum, gauze, etc. 



Procedures Against Cutaneous Hypertrophy 



of the Collar Seat (Bull's Eye 



Shoulder). 



On the shoulders of work-horses there frequently devel- 

 ops a characteristic disc-like enlargement consisting of a 

 loose, circular zone of thickened common integument upon 

 whose surface is a central denuded spot averaging about one 

 inch in diameter. The growth is naught but skin that has 

 hypertrophied and then loosened by constant collar friction 

 and pressure. In the center where the pressure is greatest 

 the epiderm is destroyed and refuses to undergo sufficient re- 

 generative activity to effectually re-clothe the breach against 



