20 X SURGERY. 



frequently : they relax the skin, promote perspiration, soothe the 

 pain, encourage the formation of pus, and hasten its progress to the 

 surface. Lint soaked in warm water may answer for a substitute. 



Abscesses need not be opened if they point, and are pyramidal, 

 and do not enlarge in circumference, but allowed to burst them- 

 selves. But they should be opened when they are beneath tendons, 

 fascia, or the thick cuticle ; when caused by the infiltration of urine ; 

 when in loose cellular tissue, with a tendency to burrow ; when near 

 a joint, or under the deep fascia of the neck, — where it is desirable 

 to obviate the scar made by the abscess opening spontaneously. 

 The best instrument for the purpose is a straight-pointed, double- 

 edged bistoury, by which the opening can be enlarged to any extent. 

 The matter should not be forcibly squeezed out, but allowed to 

 exude gradually into a poultice. By introducing a. tent the edges 

 are prevented from uniting. 



Abscesses are sometimes absorbed, especially those in glandular 

 structures and venereal cases. This can be promoted by leeches, 

 mercurial ointment, and remedies adapted to increase the general 

 health. 



Chronic abscess. — Is the result of a low degree of inflammation, 

 and is often unsuspected. It is lined by a cyst, and the pus is 

 serous or curdy. Sometimes the matter is concrete. Is most apt 

 to occur in weak and scrofulous habits, and is usually free from 

 pain, redness, swelling, &c. It may, however, become exceedingly 

 large, and from distension, inflame, ulcerate, and discharge. 



Treatment. — Improve the general health, and promote absorption 

 by means of mercurial plasters, blisters, and iodine frictions. If it 

 cannot be absorbed, it must be opened with care ; a small, super- 

 ficial abscess should be opened freely at once, the cavity injected 

 with a stimulating solution, and pressure applied by means of com- 

 press and bandage. If the matter is not freely evacujited, great in- 

 jury results from the effect of air on the contained pus; putrefying, 

 the product — hydro^ilphate of ammonia is absorbed, and the pa- 

 tient becomes typhoid. When the abscess is large, the opening 

 should be small and valvular, so as to prevent the introduction of 

 air ; or, the opening may be healed after a portion of the matter has 

 escaped, and another made ten days afterwards ; or, the part may be 

 kept constantly immersed in water. 



ULCERS. 



Ulcers are breaches of continuity of surface, the destruction being 

 caused by disease or unrepaired injury. The following classifica- 

 tion will be found to include the great majority of ulcers. 



Simple or Healthy Ulcer. — In this we have an exemplification of 

 granulation and cicatrization. The surface is covered with a thick, 

 creamy, yellow pus, not too profuse, and inodorous. The granula- 



