Icms, tli«* infusion of white poppy, or of cha- 
noraile flowers, and sometimes even volatile 
embrocations. 
When the suppurative stage of active in- 
flammation has commenced, the repellent 
applications are likewise immediately to be 
Said aside. Action is now not to be checked, 
hut encouraged; warm fomentations are to 
be applied ; poultices made with bread and 
In ilk, with a small quantity of lard or simple 
ointment, are to be resorted to ; these are to 
be laid upon the part soft and warm,, and 
very frequently to be renewed. Sometimes 
when the suppurative process seems too 
tardy and indolent, it may be necessary to 
add to the poultices some of the heating or 
stimulating gums, such as galbauum, which 
may be made to unite with the poultice, by 
dissolving it in the white of an egg. 
The completion of the suppurative process, 
or the full formation of abscess, is known by 
the cessation of throbbing, and other symp- 
toms of suppuration, and by the pointing of 
the tumour, as well as its change of colour 
■from a whitish or yellowish appearance. 
Sometimes when the" tumour is not deep 
seated, the fluctuation of matter is evident. 
The methods of opening abscess are by 
caustic, by incision, or by seton : the first, 
although still employed in som,e species of 
tumour, is at present by no means in common 
■ use ; it is more painful and insecure than the 
mode by incision. When caustic is employ- 
ed, a piece of sticking-plaster is to be laid on 
the tumour, with a hole cut into it, into which 
the caustic is to be introduced, and retained 
by plaster and bandage, until it has made an 
opening through the integuments of the tu- 
mour, which, generally, will not be till some 
hours after its application. When an eschar 
is formed, some emollient ointment is to be 
I employed to soften and separate it. 
When the knife is employed, all that is 
| necessary to attend to is, to avoid any con- 
siderable blood vessels, to make the opening 
large enough to give free outlet to the mat- 
; ter, and al the most depending part of the 
j swelling. 
When a seton is used, .such an instrument 
as represented in fig. 1, may be threaded with 
j glovers’ silk, inserted at the upper part of the 
! tumour, and passed out at the under; and 
! the matter of the abscess thus allowed gra- 
dually to discharge itself. Dry lint, changed 
! once or twice a day, is the only dressing ne- 
cessary in a common abscess. 
When an inflamed part, instead of thus 
i 1 passing on into suppuration, becomes gan- 
grenous, the external applications are re- 
quired to be of a stimulating nature ; such as 
1 solutions of sal-ammoniac, &c. in general, 
however, the arresting oi gangrene is to be 
trusted to internal invigorating powers, and 
keeping the part clear and clean. When 
mortified parts lie deep, and are not thrown 
: off by the living energy of the surrounding 
■; surface, it is often necessary to make incisions 
into the skin for the purpose of removing 
them. 
Of ulcer. When the ischar or mortified 
part has been separated, the sore remains in 
the form of a simple purulent ulcer, which is 
one of the most common objects of surgical 
| practice, the treatment of which is entirely 
1 resolvable into the means of assisting nature 
in her endeavours to procure proper and 
Vol. II. 
SUaCfEHY, 
healthy granulations of new flesh, in prevent- 
ing morbid luxuriancy, and disposing to an 
even aud clear cicatrization. Various me- 
thods have been had recourse to, in order to 
accomplish these objects, such as turpentine, 
warm stimulating ointments, in conjunction 
with mercurial preparations ; as an example 
of which, and as the best application of the 
kind, we may notice the common basilicon 
ointment of the shops, with the red-precipi- 
tate powder. But the management of obsti- 
nate ulcers has. recently been abundantly 
facilitated by the employment of simple ad- 
hesive plaster, which is cut into strips, and 
laid carefully, firmly, and neatly, over the 
whole ulcerated surface ; these, where it can 
be used, to be assisted by bandage. This 
practice was first generally introduced by 
Mr. Baynton,and has, with justice, been rank- 
ed among the highest improvements in mo- 
dern surgery. At every dressing of an ulcer 
thus treated, the sore is first to be cleansed 
by sponge and warm water; if, notwithstand- 
ing the uniform pressure of the plasters, fun- 
gous excrescences arise, they may be touch- 
ed, when dressed, with some kind of escharotic ; 
the edges of the ulcerated surface are then to 
be brought up as near together as the loss of 
substance will admit of; and the strips of 
adhesive plaster separately passed over the 
sore, till it is entirely covered. Over this 
dressing common cerate spread on linen may 
be laid, and the bandages then applied. 
When the nicer is attended with much in- 
flammation and swelling, the management 
of it for a time is to be solely entrusted to 
warm and stimulative poultices. One of the 
most efficacious materials of which these 
may be constituted, and one of the best ap- 
plications to obstinate ulcers of the leg, which 
ae often attended with erysipalatous inflam- 
mation, is the grounds of stale beer. 
Thus far of ordinary inflammation and its 
consequences: we now proceed to treat of 
this state as connected with, or modified by, 
a peculiarity of constitutional disposition. 
These kinds of inflammation are peculiar in 
their nature, and confined to certain parts of 
the system. Thus, inflammatory disorders of 
a scrophulous kind invariably affect secretory 
surfaces and cancerous inflammations, which 
are nearly allied to scrophulous, arise always 
in glandular parts. Suppose, for example, 
the breast of a female to be subjected to the 
causes of inflammation, the operation of such 
causes, if applied at a certain time of life, or 
under circumstances of cancerous predispo- 
sition, will end in the production of true 
cancer ; the nature of the inflammation from 
the first being peculiar : while under circum- 
stances of freedom from the cancerous ten- 
dency, an equal degree of actual inflam- 
mation may prevail in the breast, without 
having any peculiarity in its nature and pro- 
gress, or without demanding a specific mode 
of treatment. Further, even in an individual 
predisposed to cancer, inflammation of a 
part which is not glandular, will, by conse- 
quence, not be cancerous. What, therefore, 
we have denominated constitutional inflam- 
mations, are inflammations of certain parts, 
and thus branch out into distinct diseases. 
We shall here only notice the two principal 
inflammations from a scrophulous diathesis, 
although every secretory surface is obnoxious 
to the atfeetion ; these are white-swelling of 
the knee joint, and lumbar, psoas abscess. 
7 15 
tl'h itc-szaelling, This disorder is most Ire 
queut in the knee joint, and indeed the name 
is usually made to denote a disease of this 
part. 
Symptoms. Pain in the joint, especially on 
motion, or, when it is in a bent position, 
swelling, which gradually augments, with an 
enlargement and varicose appearance or the 
cuticular veins; while the joint swells, the 
parts below become either diminished or 
affected with an ceuematous enlargement, par- 
tial suppurations, which break and form ab- 
scesses at different points; gradual decline of 
t lie patient’s health, hectic fever. Sometimes 
the pain is more confined, and it is often theft 
more acute ; at other times the pain and 
swelling are from the first diffused through 
the whole extent of thejoint. 
Causes. White-swelling is a scrophulous" 
inflammation. In those cases in which the 
enlargement of the joint commences with the 
pain, the pain itself being more diffused, the 
primary affection seems to be an inflamed 
state of the capsular ligament ; in other cases 
the disease is perhaps originally seated in the 
bones. Mr. 13. Bell has described these dif- 
ferent species by the names of rheumatic and 
scrophulous ; but the fact is, that they both 
depend upon the scrophulous diathesis; and 
it lias been well observed by an able writer, 
“ that between acute rheumatism and white- 
swelling, there is no sort of analogy, neither 
as to their causes, their symptoms, their 
terminations, their proper method of cure, 
nor any thing else.” Dr. Iierdman on White- 
Swelling. 
Treatment. Both in the medical and sur- 
gical treatment of all scrophulous inflamma- 
tions, it must be recollected that they par- 
take more of the asthenic than the opposite 
character. Tftus in white-swelling, however 
violent the inflammation, or urgent the pain, 
blood-letting, general or local, is seldom or 
never advisable. Blisters, warm fomenta- 
tions, and bathing, volatile liniment, the 
counter irritation of caustic issues, mercurial 
friction, nourishing, but not irritating, diet, 
good air. When suppuration has taken 
place, “ soft and easy dressings,” warm poul- 
tices, small doses of calomel with opium. 
Cicnta? Amputation of the limb, which is 
often the only resource of the surgeon, yet it 
is not indiscriminately advisable, on account 
of the patient being, in some instances, too 
feeble and diseased to admit of the operation. 
Of lumbar or psoas abscess. 
Symptoms, l’ain in the loins, which does 
not, as in lumbago, affect the muscles of the 
loins generally, but passes rather upwards in 
the direction* of the spine, and downwards 
in an oblique direction, towards the inner 
part of the thigh. After the existence of 
this pain, for a longer or shorter period, 
marks of suppuration come on, and a tumour 
gradually appears in the groin. This is to be 
distinguished from hernia by a recollection of 
the preceding symptoms, and by the flaccidity 
and fluctuating feel of the swelling. 
Causes and seat. This disease appears to 
be an inflammatory affection of the vertebral 
ligaments, occasioned by sudden alterations 
of temperature, blows, or any violence done 
to the part, and other causes of inflammation v 
It terminates in suppuration, which runs along 
the sheath of the psoas muscle, and thus ap- 
pears i» tjje groin. 
