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jeift defen-e particular attention — See the article Fistu- 

 lous Ulcer. 



Abscess in the Groin nnJ Arm-pil. The inflammation 

 and tumefaftion which occur in thel'e iituations, genenlly 

 arife from a difcafe in the ablorbent glands ; fomctimes they 

 are occalioned by an injury fullained by a dillant lymphatic 

 veffel, communicating witb the inflamed gland; and not un- 

 frequently lucli glandular affetlions are the confequcnce of a 

 malignant conftitutional dilbrder, fuch as the plague or 

 VENEREAL DISEASE, when they are denominated Buboes. 

 See thefe terms in their refpettive places. From wr.atcver 

 caufe abfccITes arife in the ablorbent fyftem, they are moftly 

 tedious and difficult to cure. See Absorbents, and their 

 difeafes. But when they h:;ppeu in the groin or axiila, it is 

 clpecially requifite to avoid making deep incifions, on ac- 

 count of the large blood veffels there fituated : in other re- 

 fpecls they require no peculiar management, except that, 

 being very flow to fup;5in-ate,it will often be neceflary to apply 

 ftimulating plallers or cataplafms ; and when they arrive at 

 a ilate of perfeft maturation, it will much accelerate the 

 ciu-e to evacuate the pus by a cauftic inllead of a punfture 

 or mere incifion. A fcrofulous habit of body very common- 

 ly gives rife to glandular enlargements ; in fuch cafes it will, 

 therefore, be proper to employ the appropriate internal 

 means, without which external remedies will often prove ufe- 

 lefs. See Scrofulous Tumors and Ulcers. 



Abscess /n the Loins; olherwife called the Pfoas or 

 Lumbar Ahfcefs. The large mufcles fituated within the 

 loins, and their connedling cellular fubftance, are very liable 

 to inflame, and foiTn extcnfive colleCTiions of pus. Thefe 

 are fo important and ferious, even under the moll favourable 

 circumftances, that comparatively few perfo:is recover from 

 their effefts. This confid;ration fliould urge praftitioners to 

 adopt decifive means of rehef in the earlieft period of the 

 complaint, and never to make light of the fymptoms which 

 indicate a fixed inflammation in the lumbar region. When 

 pus has aiilually formed, we ouglit not abfolutely to defpair, 

 but the principal hope lies in preventing its formation : it is, 

 therefore, of great confequence to afcertain the exa£l ftate 

 of the patient when he firft applies to the furgeon. An in- 

 cipient lumbar abfcefs may be fufpefted, if the patient has 

 been lately expofed to any of the exciting caufes of inflam- 

 mation ; if a dull and conftant pain aftefts him in the deep 

 feated mufcles of the loins ; if this pain be aggravated in raif- 

 ing and rotating the thigh ; if a fenfe of tightnefs or con- 

 finement be felt within the belly, or near the groin, accom- 

 panied with external tendernefs to the touch ; if there be 

 much difficulty in ftanding ereft, or in lying at full length ; 

 and if, in addition to thefe fymptoms, the patient be of a- 

 delicate and fcrofulous habit of body. When matter is 

 formed in conliderable quantity, a new fet of lymptoms and 

 a more decided character will be attached to this difeale : 

 the UitTerer will experience nofiurnal exacerbations of fever^ 

 with frequent rigors, languor, and lofs of appetite, walling 

 of the body, night fweats, hcftical complar.its, and an ex- 

 ternal protuberance in the v'cinity of the al feels. The mat- 

 ter, however, does not uniformly fluftuate in any particular 

 fpot, but may be felt fometimes about tlie loins, near the 

 hip, or in the groin, ai.d fomttimes at the anus, or tow.r-ds 

 the bottom of the thigh. This tumor will generally 'dimi- 

 nifli, owing to the retroceffiou of the pus, on placing the 

 patient in an horizontal pofition. During the increafe of 

 the fuppuration, there will often be fuch a lemiflior'. of the 

 fymptoms, that the patient imagines himfclf in a Hate of rc^ 

 covcry, until a fpontancous rupture '.akes place in the 

 fwelling,. or it requires an artificial opening. Now and then 

 fome of the lumbar vertebrK become carious, Iroro the prcf- 



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fure of the contignons pus, and the lower extremities arp pa- 

 ra'yfd ; the large blood-veffela may be crod d, and thus, a 

 fpe dy temiination is put to tiie patient's exi!l-.-ncc. 



The early remedies to be employed in this difcafe, before 

 fuppuration has commenced, are free topical bloodleltinjj, 

 by the repeated ufe of fifteen or twenty leeches, or by the 

 fcaril'cator and cupping glafs ; the exhibition of fdine pur- 

 gatives ; a mild vegetable diet ; perfeiil tranquillity and rcll ; 

 with repeated blilltring, or a large caiiflic, over the alfefted 

 part of the loins. But, as fuppuration advances, the diet is 

 to be im.proved ; fomc animal food and wine mull be allow ed ; 

 tonic and acid medicines are to be employed ; with country 

 air, moderate bodily exercife, warm fea-bathing, and clicar- 

 ful company. When the fuppuration is far advanced, if it 

 be judged proper to make an outlet, the bed method is to 

 evacuate the pus by a very fmall oblique .aperture, with a 

 broad lancet or trocar. Mr. Abernethy advifes us to 

 empty the abfcefs early and complete'}- ; then to bring the 

 lips of the wound in contaft, and by means of lint and kick- 

 ing plaller to keep them together ; and over thefe to apply 

 a luitable bandage. The wound heals, in general, without 

 much difficulty, and requires dreffing only once in two davs. 

 When the flcin again projects, from the preiTure of the fub- 

 jacent matter, another punfture may be made ; and thus, 

 the evacuation is to be rei)eated as ofti^i as fliall be neceflary-, 

 avoiding any permanent expofure of the cavity of the ab- 

 fcefs. Among the means which have been fuccefsfu'ly 

 employed on thefe occafions, are emetics, injections, opium, 

 cinchona, and eleftricity : but for a more detailed account 

 of the treatment, we recommend the perufal of Mr. Aber- 

 nethy's ElTays, and Mr. Bell's Syllem of Surgery. 



Abscess in the Mufcles of the Belh. The principal obiVfl in 

 this cafe, is to prevent the matter from hurtling internally ; 

 fince fuch an event might prove fiital. The furgeon fliould 

 therefore open the abfcefs earlv, and endeavour to ufe thofe 

 kinds of bandages, or comprefies, which may obviate future 

 colleftions, and the formation of linuous ulcers. 



Abscess of the urinary BladA'r. Wiien an accumulation 

 of pus or mucus occurs in the bladder, mild emollient injec- 

 tions may be ufed by means of a fyringe and catheter. This 

 praClice has been lately taken notice of as new ; but it was 

 recommended by the Arabian phyficians, and by fome of the 

 oldeft European praftitioners, who perhaps took the hint 

 from Albucafis. 



Abscess under the Cranium, •within the cylin/lrical bones. 

 No other remedy can be here advifed, for giving free 

 vent to the confined matter, thaLi perforating the bone 

 v;ith a trephine. 



Abscess under the Sternum. When pus lies immediately 

 under the chell-bone, within the dupiicature of the mediaf- 

 tinum, the fui-geon will not hefitate to apply a trephine. Au 

 intc-clling paper on this fubjeiil may be feen in the I Jth 

 number of the London MediciJ Review and Magazine. Mr. 

 Blair's Obfervations on a fuccefsful cafe of this kind, arc 

 likewife contained in the 4th volume of that work, page 



A.BSCESS of the Thorax. See Empyema. 



Abscess of the Breaft. The mammary abfcefs may be 

 produced by any of the remote caufes of mflrmmation, but 

 is (iioftly occafioned by a redundance of milk foon after par- 

 turit.on. In general it might be prevented by an immediate 

 application of the infant to the breafts after delivery, or at 

 ha I before they are turgid with milk. See 1.'<flammatiom 

 of the Brciift. When pus is aclu;tllv formed, a fiift, warm, 

 emollient poultice, comjiofed of bread and milk, or of a 

 decoction of popp'es and liuf'ed nie;d, Ihouid be conllaiitly 

 kepi upui) tiie pKitj and renewed every tlirec or four hounj ; 



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