COLD ABSCESSES AND THEIR TREATMENT. 
221 
From the character and extent of the pathological changes 
taking place in the deeper muscular layers and areolar tissues 
of that region of the neck, and the pressure produced thereby, 
an oedema takes place, causing a soft doughy swelling, consid¬ 
erably diffused, extending on all sides of the seat of injury, 
which may cause the skin to be raised an inch or more and 
circumscribed eight or ten inches, but in the course of a few 
days the oedema begins to decrease by absorption or infiltrates 
through the cellular layers to the lower portion of the pec¬ 
toral region, gradually passing away. 
In cases where there is a considerable accumulation of pus 
and a tendency to point, there will be extreme sensitiveness, 
but in the majority of cases there is very little pain on pres¬ 
sure, and the tumor becomes more and more defined, and can 
be moved about from side to side, resembling a fibrous struc¬ 
ture, but not with the same looseness of a well defined fibroma, 
which may lie loose in the areolar tissue or be held by a 
pedicle. After the oedema passes away and the tumor becomes 
more prominent, it gradually increases in size and becomes 
very large, with no tendency to point, and becoming firmer 
and harder, though fluctuation can be detected. 
At times it becomes very difficult to diagnosticate between 
these abscesses and other conditions resembling them, on ac¬ 
count of the impossibility of determining fluctuation. The 
history of the case helps considerably in forming an opinion; 
the mode of origin, its slow and steady growth, its resistance 
to external applications, the peculiar character of the swelling 
and the absence of pain—all of these help to decide the 
nature of the enlargement, but to determine the character 
without a doubt is by exploration; an exploring needle or 
trocar and canula should be introduced and the nature of the 
fluid, if present, will decide. In the absence of pus, serum or 
blood, the tumor being well defined and movable, a fibroma is 
usually met with, but sometimes, on account of the cavity be¬ 
ing so small and so deeply seated, there is a possibility of not 
plunging the exploring needle into the contents of the cavity 
and misleading the surgeon. 
The treatment of these abscesses has been a vexed ques- 
