A B S 



this and other chirurgical cafes, is explained imder the 

 tcnn Caustic. 



2. Aa incifion or a pimclure is employed rather than t'.ie 

 caullic, where the fuigciu p-.Mpofcs to Lt out only a part 

 of the contents of the ubfcefs at once ; where it is neceiiary 

 to li.uit the extent of the artificial opening to certain diinen- 

 fions ; wlicre tlie pus lie"! too deep for tl>e precarious opera- 

 tion of an cfcharolic fubll.mce ; where an immediate outlet 

 is required, and danger is apprehended from delay ; or, 

 wliere it is reipiifite to make a wide incifion, for the pur- 

 pofe of f leihtating the difcharge, or applying external nie- 

 dicamc.it.i to the bottom of the fore. The precife circum- 

 ftanres rtiiuirir.jr a variety in the plan of treatment, will be 

 explained in the parajjr.ipiiB which follow, while we dclcribe 

 the dilfercnt kinds of ablceifes that occur in fever.d parts of 

 the body. 



3. Another mode of opening abfceircs is by the fcton, 

 which coiififls in pafTiiig a /kein of foft thread or lilk 

 through the parietcs of the tumor, by means of a se- 

 TON-needlc. This praftice Is very common in the veteri- 

 nary art, but is not much employed on the human fubj^cl. 

 Setons are apt to produce adh^fions between the ficin and 

 fubjacent mufcle ; the fear which they leave, however, is 

 ^.nei-ally but fmall, and for this rcafon they are fometimes 

 advantageoully had recourfe to in fuperficial collections of 

 matter about the neck and face, where fuppuration is 

 likely to continue a long while. They are alfo uled in cer- 

 tain cafes of abfcefs near a joint, or other important part, 

 which might be injured by the fcalpel or caullic, or which 

 does not admit of a wide orifice being made, fo as to expofe 

 the abfceded furface to the air. 



Treatment of parl'icular Abscesses. 



There arc certain general principles in the management of 

 abfcefies, from which furgeons do not greatly deviate in 

 common cafes ; fuch, for example, as the applying of warm 

 and llimulating applications to the part affected, where the 

 intention is to accelerate the fuppuration : when the pus is 

 to be evacuated, they not only make an artificial opening, 

 hut afljil the daily jifcharge by comprcfTes, or by lightly 

 filling the orifice with eafy drefiings ; and, when there is 

 a tendency in the fore to granulate, they remove all exter- 

 nal obilacles, and ufe fuch gentle means as are calculated to 

 aid tlie healing proccfs of nature : at the fame time internal 

 remedies areadminiflered, according to the nature of thefymp- 

 toms, and the ftatc of the patient's conftitution. But, we 

 fhall proceed to iUuttrate thefe general remarks by an example. 



Suppofe an extenfive inflammation of the phlegmonous 

 kind to have taken place in a robuft young perfon, upon a 

 flefhy part of the body. If no eflfective topical means have 

 been ufed to allay the pain, heat, and tenfion ; if no general 

 or local bleeding has been employed ; if the patient be not 

 abftemious in his diet, nor has had recourfe to purgative 

 remedies ; under fuch circumftances it is very probable the 

 inflammation will advance rapidly, and tennlnate in complete 

 fuppuration. In this latter flage of the cafe, warm emolli- 

 ent poultices and fomentations fhould be applied three or 

 four times a day ; and, if the inflAmmatoiy fymptoms be- 

 come excelfive, the cooling regimen, with moderate bleed- 

 ing, and mild fallne purgatives may he advantageoudy 

 employed. Thefe laft (hou'd, however, be cautioufly and 

 fparingly ufed, left the fuppurating procefs be too far 

 checked or interrupted. When the pus has forced its way 

 towards the fui-race of the limb, and is nearly ready to burft 

 from the tumor, (which will be known by a palpable 

 fliidtuation of the matter, and by the integument becoming 

 ihjn.) prudence Aiggefts that a luiHcient opening fhould 



A B S 



he made for the free and perfed evacuation of the contents 



of the abfcefs. 



But there are circumftances which fometimes 



forbid our waiting till this critical period ; the matter mar 

 be confined within a cyft ; it may be retained by a thick and 

 firm fafcia lying over it ; for want of an outlet, it may be 

 actually re-a'bforbed into the general fyftem, and circulating 

 with tlie blood, may produce very ferious confequences to 

 the patient's health : in order, therefore, to prevent the 

 inconveniences which might enfue from long waiting, a judi- 

 cious furgeon forefeeing the evil, will evacuate the pus by 

 an early opening. In making his incifion, it fhould be an" 

 invariable rule to cut in the direction of the mufcular fibres ; 

 left, by a tranfverfe wound, fome important pai-t be deprived 

 of its action through life : by neglecting to oblerve this rule 

 in an impollhume of the forehead, an ignorant operator de- 

 prived his patient of the power of opening his eyes, fo that 

 he was obliged to pafle up his eye-brows with adhefive plaf- 

 ters, in order to enjoy the benefit of vifion. It is alfo necef- 

 fary, in ufing the fcalpel, to recolleft the fituation of neigh- 

 bourincr blood-veffcls and nerves ; taking the precaution to 

 employ a grooved direftor, whenever tliere is the fmaUefl: 

 danger of cutting thefe organs. The fubfequent di-eflings, 

 BANDAGES, &c. &c. will be nearly the fame as are required 

 in common ulcers or wounds ; for an account of which, 

 to avoid prolixity, we refer the reader to thofe articles. But 

 it will now be proper to point out the plan of treatment ta 

 be adopted in (ome peculiar kinds of ii!ifcefs. 



Abscess of the maxillary fmus. The cavity of the cheek- 

 bone. Antrum Highmorianum, is lined with a delicate vaf- 

 cular membrane, which, when it inflames and fuppurates, 

 produces great pain in the upper teeth, nofe, and tlie eye of 

 the iide affeCled ; it is alfo very common for people with 

 this complair.t to have a fevere pain in the forehead, where 

 the frontal finuffes are placed ; but ftiU thefe fymptoms are 

 not fufficient to dlliinguifh the difeafe. Time muit difclofe 

 the true caufe of the pain, for it wjl frequently continue 

 longer than that which arifes from a difeafed tooth, and will 

 become more and more fevere ; after which, a rednefs will 

 be obferved on the foi'e-part of the cheek, fomewhat higher- 

 than therootsof the teeth, andan induration at the fame place, 

 vrhich will be confiderably circumfcribed ; this hardnefs may 

 be felt rather highly fituated on the infide of the lip. The 

 method of cure confifts in extracting one of tlie tleiites molares 

 from the affefted fide ; and then perforating through the focket 

 into the bony cavity. A mild injeCtion may afterwards be em- 

 ployed to cleanfe the finus, and be repeated as occafion re- 

 quires. Confult Gooch's Cafes, Hunter on the Teeth, and 

 Bernftein's Handbuch. 



Abscess near the Anus. Any of the caufes of inflamma- 

 tion, whether internal or external, may produce this difeafe. 

 It is generally flow and infidious in its progrefs, involving 

 the reftum, and adjacent cellular membrane in its ravages ; 

 for the molt part it is painful and tedious, occafion: ng deep, 

 fillulous, and callous orifices, which demand prompt atten- 

 tion from the furgeon. See Fistula. The chief injlca-. 

 tlons are, to alleviate the pain by glyfters, fomentations, and 

 emollient poultices ; to make a free opening as foon as the 

 pus is fairly within reach of the knife ; to divide all the finuo- 

 fities, if they communicate with each other, fo as to effeA 

 one general outlet ; and, when the inteillne has been laid 

 bare or perforated, by the confined matter lying upon it, 

 to rip it up with a cun'ed biftory, guided by the operator's 

 forefinger. Recourfe muft alfo be had to internal medicines 

 whenever the patient's health is deranged ; a.id indeed, 

 vv'ithout fuch collateral aid, the furgeoa's effi^rts will fre- 

 quently be in vain. Mr. Pott's obfervations on this fub- 



jea 



