File:American practice of surgery; a complete system of the science and art of surgery (1906) (14576556770).jpg

Identifier: americanpractic07brya (find matches)
Title: American practice of surgery ; a complete system of the science and art of surgery
Year: 1906 (1900s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914, ed Buck, Albert H. (Albert Henry), 1842-1922
Subjects: Surgery
Publisher: New York, W. Wood and company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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tweentrue dermoids, the lining ofwhich shows the true struc-ture of the cuticle (i.e.,hair follicles, sebaceous andsweat glands), and epidermoid cysts, the walls of which consist simply of connec-tive tissue lined with pavement epithelium. Symptoms.— There are no symptoms, except the presence of a fovea or asinus opening, until the retained epithelial detritus, etc., form a cyst or tumor,or, more commonly, become infected and form an acute abscess. If this isallowed to burst spontaneously, as is frequently the case, a sinus persists, or theopening heals and a secondary abscess forms. This process may be repeated anumber of times before the patient seeks surgical relief. Diagnosis.—When the opening of the suppurating sinus lies to one side ofthe median line, and the site of the original fovea is closed or indistinct, the con-dition may be mistaken for necrosis of the sacrum or coccyx; or, if the openingis situated low down, it may even be mistaken for a fistula in ano. Tuberculosis
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Fig. 17.—Sacro-Coccygeal Cyst in a Man, twenty-nineyears of age. (Original; drawn from life.) Note the shining,pearly, epithelial lining of the sac, closely adherent to theperiosteum of the sacrum. Suppuration occurred in the third week of a severe attackof typhoid fever. The swelling was incised under cocaine an-sesthesia, and the opening was allowed to heal by granulation. SURGICAL DISEASES OF THE PELVIC REGIOX. 23 or syphilis may be suspected, and in certain eases of decubitus, with a small areaof necrosis in this region and a large infected retrosacral subcutaneous bui-sa,one may confuse the condition with an infected congenital sinius or cyst. In thecase shown in Figs. 17 and IS the reverse error in diagnosis was at fiist made,the extremely low, typhoidal state of the patient suggesting an ordinar)- bedsore. Necrosis of the sacrum or coccyx is easily excluded by the absence of barebone, as well as by the usual appearance of the openings which are clean cut/andinto which the epi

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