632 PRACTICE OF I'HYStC. 



swellings ; but a tumour almost uniformly surrounding the 

 joint, and interrupting its motion. 



MDCCXLIV. These tumours, as I have said, remain for 

 some time little changed ; and, from the time they first appear- 

 ed in the spring, they often continue in this way till the return 

 of the same season in the next or perhaps the second year after. 

 About that time, however, or perhaps in the course of the sea- 

 son in which they first appear, the tumour becomes larger and 

 more fixed ; the skin upon it acquires a purple, seldom a clear 

 redness : but growing redder by degrees, the tumour becomes 

 softer, and allows the fluctuation of a liquid within to be per- 

 ceived. All this process, however, takes place with very little 

 pain attending it. At length some part of the skm becomes 

 paler ; and by one or more small apertures a liquid is poured 

 out. 



MDCCXLV. The matter poured out has at first the ap- 

 pearance of pus, but it is usually of a thinner kind than that 

 from phlegmonic abscesses ; and the matter, as it continues to 

 be discharged, becomes daily less purulent, and appears more 

 and more a viscid serum, intermixed with small pieces of a 

 white substance resembling the curd of milk. By degrees the 

 tumour almost entirely subsides, while the ulcer opens more, 

 and spreads broader, unequally, however, in different direc- 

 tions, and therefore is without any regular circumscription. 

 The edges of the ulcer are commonly flat and smooth, both on 

 their outside and their inner edge, which seldom puts on a cal- 

 lous appearance. The ulcers, however, do not generally spread 

 much, or become deeper ; but at the same time their edges do 

 not advance, or put on any appearance of forming a cicatrix. 



" In the case of scrofulous tumours, we find sometimes a 

 suppuration which is of the ordinary kind, and this we may re- 

 fer to the cellular texture surrounding the conglobate glands : 

 but fof the most part, where there is an effusion, we find a white 

 caseous matter in some sac, which must be referred to the par- 

 ticular nature of the part there ; and in how many different 

 parts this peculiar appearance may be produced, or how much 

 the appearance may be affected by the particular state of the 

 part, we cannot say." 



