SURGERY. 



461 



ity to perform, and this operation is sometimes 

 advisable, even in the first or inflammatory stage, 

 where there is great tension, accompanied with 

 severe pain. 



Erysipelas, or rose, is generally the kind of in- 

 flammation that occurs after phlebotomy at the 

 bend of the arm. The inflammation begins in or 

 near the wound, which it soon surrounds as a circular 

 ray, which speedily spreads both upwards and down- 

 wards. The whole arm is swollen, the skin has a 

 delicate rosy tinge, and is clear and shining, and 

 when pressed with the finger or thumb, a white 

 mark appears for a minute or so. There are occa- 

 sionally serous vesicles or small blisters, like those 

 occasioned by scalding water, and a yellowish hue 

 is frequently observable. The vesicles either dry 

 up or burst, and desquamate or ulcerate, or even 

 slough and ulcerate. There is a hot burning pain 

 in the part, and, very early in the disease, there is 

 inflammatory fever and nausea, affording proof that 

 the constitution is affected. Some hare affirmed, 

 that the wound of the vein often heals before the 

 erysipelatous affection takes place, and even con- 

 tinues to heal, but it sometimes breaks out, and dis- 

 charges a sanious matter. The plan of treatment is 

 the same as that recommended in inflammation of 

 the vein or bleeding blisters, poultices and ano- 

 dyne fomentations. This has been established by 

 experiment and facts, that in cases of this affection, 

 a vein opened in the opposite arm never assumes 

 the erysipelatous type, nor do leech-bites, according 

 to the common, and indeed long received opinion, 

 mortify. The extension of the inflammation is 

 often arrested by blisters, and the blistered surface 

 never assumes the erysipelatous action, but on the 

 contrary limits it. " Warm poultices," says professor 

 Lizars, " are as beneficial in erysipelas as in phleg- 

 mon. Flour is a common, but most inert application. 

 Solution of the sulphate of magnesia, (epsom salts) 

 with tartrate of antimony, is found to be an excel- 

 lent aperient. Emetics are pernicious remedies, 

 particularly when the head is the seat of the dis- 

 ease, as they propel the blood to that organ. When 

 erysipelas attacks the face or scalp, it ought to be 

 treated with great promptitude, in consequence of 

 the vicinity of the brain, and when either of these 

 parts have been attacked, it is peculiarly liable to 

 return on the slightest exposure to cold. It is 

 very apt to move from one place to another, in this 

 manner extending all over the body, from the head 

 down to the back and breast to the arms, and even 

 the legs, the one part desquamating as the other 

 makes its appearance. Erysipelas is subject to be 

 translated from one part of the body to another, 

 like rheumatism, from the leg to the lungs or face, 

 and it occurs periodically in some individuals." 

 This, however, is a subject the farther prosecution 

 of which belongs rather to the science of medicine 

 than that of surgery. 



Having now described the different means of 

 blood-letting, the diseases in which it is employed, 

 or its uses and abuses, and likewise those accidents 

 or diseases arising from a careless or unskilful per- 

 formance of the operation ; we now direct our at- 

 tention to some other departments of domestic or 

 popular surgery, most easily understood and prac- 

 tised by the uninitiated. 



Opening of Abscesses. This is, perhaps, next to 

 blood-letting, the most commonly practised opera- 

 tion, and, except, when the abscess bursts, is em- 

 ployed where a quantity of matter is collected in 

 any external part of the body. Abscesses are 



formed by the termination of inflammation in sup. 

 puration, or bealing, as it is called in Scotland. 

 They are known to be fully formed, and in a pro- 

 per state for being opened, by the cessation or abate- 

 ment of the violent throbbing pain which takes 

 place in the first and second stages of inflammation, 

 and the coming on of a dull heavy pain, which con- 

 tinues constantly without any intermission. The 

 swelling becomes more prominent, and draws to a 

 point generally in the middle. This prominent 

 part generally changes its colour to a yellowish 

 white ; and if the abscess be not very deeply situated, 

 the fluctuation of a fluid is very plainly perceptible. 

 Sometimes, however, when the matter is collected 

 below the muscles, the fluctuation can scarcely be 

 perceived or but very indifferently, and the abscess 

 is then much more diffused than in the former 

 species. All large abscesses are likewise attended 

 with shiverings, especially if seated in any of the 

 internal viscera; and even where the collection is 

 not very considerable, the patient is liable to them 

 on the first formation of matter, their severity and 

 extent depending either on the size of the abscess, 

 or its situation in the body. 



In the treatment of abscesses, it is laid down as 

 a general rule, not to open them while any con- 

 siderable degree of hardness remains, as this is evi- 

 dence the matter is not yet fully formed. There 

 are particular cases, however, in which there is a 

 partial deviation from this rule, particularly in those 

 that are seated in the thorax or abdomen ; for when 

 large collections of matter are formed upon these 

 parts, they are as ready to burst internally as exter- 

 nally, and the consequences to the patient, in that 

 case, might be fatal, or at least attended with great 

 trouble and inconvenience. Therefore where such 

 abscesses occur, they ought to be opened as soon as 

 any fluctuation, however small, can be perceived. 

 When opened at such an early period, it is true 

 that an abscess does not heal so easily or kindly as 

 when the operation is deferred till they come to 

 maturity, but here the danger outweighs every 

 other consideration. Those abscesses too, which 

 accompany or are the result of malignant fevers, 

 should be opened at an early period, because the 

 pus that is formed, differs from that of a common 

 abscess, and by reason of its virulent nature, would 

 augment the disease. Indeed the naturally mild pus 

 or matter of a common abscess, if confined too long 

 in the cyst, will turn very acrid ; and by being ab- 

 sorbed into the blood, will produce hectic fever, 

 which it is often difficult to subdue. 



An abscess being in a fit condition for opening, 

 it is worthy of consideration what is the best mode 

 in which the operation is to be performed. There 

 are three modes employed in modern practice, viz. 

 incision with a knife, history or abscess lancet, or 

 even a common lancet, by application of caustic or 

 the introduction of a seton. 



The method pursued in the first case, is to make 

 an incision of such a size as may give free vent to 

 the matter, and this incision should be in the 

 lowest or most depending part of the tumour, and 

 of the extent of the incision the operator must 

 judge from the nature and size of the sac. It was, 

 and indeed still is, the practice with some surgeons, 

 to make the incision through the whole length of 

 the tumour, and some have resorted to the foolish 

 expedient of cutting out a portion of the skin, in 

 order to give more free vent to the matter, and as 

 if the skin had not the power of assuming its wonted 

 dimensions. When abscesses are connected with 



