PATHOLOGY. 
230 
tion common to the fiefhy parts; pain obtufe; tumour 
fpreading externally; tender to the touch; pus laud¬ 
able ; readily incarning when opened. See Surgery. 
2. Apodema pfoaticum, pfoas abfcefs: pain and tenfion 
about the loins, (hooting down the (pine and thigh; dif¬ 
ficulty of (landing ereft ; fiudluating enlargement along 
the pfoas tnufcle; apex of the tumour immediately be¬ 
low the groin. See Surgery. 
3. Apoftema hepaticum, abfcefs of the liver: diffufe 
pulfating tumour in the region of the liver; preceded by 
pain, a yellow countenance, and fhiverings. 
This is by no means a common complaint in this 
country; but it is met with in hot climates, where in¬ 
deed the medical practitioners are faid to be remarkably 
expert in performing an external operation for its relief. 
We fhould take efpecial care to prevent fuppuration from 
happening in this important organ, by aftive treatment 
during the inflammatory period of the complaint. Sup¬ 
puration is prognofticated if inflammation continues in 
the liver feveral days; if the pain remits, and is followed 
by a pulfation in the fame place, and if fhiverings come 
on, with a countenance of a yellowifh colour ; foon after 
which a tumour and a fenfe of weight are perceived in 
the region of the liver: a heftic fever follows, with third, 
and extreme feeblenefs. Aretasus obferves, that pain 
generally extends to the throat, and to the extremity of 
the (houlder ; and a dry, but not very frequent, cough 
afflidls the patient. He further remarks, that this dif- 
order is fotnetimes miflaken fora tumour of the perito¬ 
naeum ; but that the latter is more irregular, and is not 
circumfcribed by the limits of the hypochondrium. 
The favourable termination of this complaint depends 
on the manner in which the abfcefs burfls. If externally, 
we may entertain fome hope ; if internally, at the cavity 
of the abdomen, it is for the mod part fatal. See Hepa¬ 
titis. 
4. Apodema empyema, lodgment of matter in the 
ched: fixed pain in the chefl ; breathing laborious, but 
eafiell in an ereft pofition ; difficult decumbiture on the 
found fide ; fiudluating enlargement on the fide ad'edled; 
dry tickling cough. It is often brought on by difeafed 
adlion in the pleura without ulceration. There is reafon 
for believing that matter is contained in the cavity of 
the chefl, when, after a pleurify, or inflammation in the 
thorax, the patient has a difficulty of breathing, parti¬ 
cularly on lying on the fide oppofite the affedted one ; 
and when an cedematous fwelling is externally percep¬ 
tible. The malady is fometimes relieved by the opera¬ 
tion ofparacentefis thoracis, (fee Surgery;) and cafes 
are related in which the matter is faid to have been ab- 
lorbed. 
5. Apodema vomica: deranged fundlion of a thoracic 
or abdominal organ,fucceeded by copious difchargeof pus 
into fome part of the alimentary channel, and its evacu¬ 
ation by the mouth or anus. 
The term is here ufed in the large fenfe in which it is 
employed by Celfus, who applies it to a burding of pus 
from the liver, or any other large internal organ, as well 
as from the lungs. “ Si vero jecur vomica laborat, eadem 
facienda funt, quse in ca^teris interioribus fuppurationi- 
bus.” Lib. iv. cap. 8. Sauvages follows him in this in¬ 
terpretation. Boerhaave and Cullen confine vomica to 
the lungs, and that in a more reftrained fenfe than mod 
writers ; for they limit it to what has been called, though 
with no great accuracy, occult vomicae (vomica clauja). 
Linnteus and Vogel, on the contrary, while they confine 
the term to the lungs, explain it by open vomicae (vo¬ 
mica aperta ), in which the pus is thrown forth profufely 
and fuddenly 
Genus II. Plilegmone, [from (pXiyu, to inflame.] Phleg¬ 
mon ; abfcefs or tumour near the furface. Generic cha- 
raflers— Suppurative fubcutaneous tumour ; tenfive; 
glabrous ; painful; at length fiudluating, and burding 
fpontaneoufly ; the pus uniform and mature. 
+ 
The treatment of phlegmon is to be conducted, as far 
as local treatment is regarded, by topical applications, 
which are generally either cold or warm lotions. Heat 
is well known to promote and increafe all animal aflions, 
and mud therefore tend to keep up and augment the 
procefs of inflammation. Hence arifes the indication 
to diminifh the heat of the part affedled, by making ufe 
of cold topical applications, and maintaining a continual 
evaporation from the inflamed furface. The common 
plan is to dip linen in the faturnine lotion, and, after 
folding it once or twice, lay it all over the part affedted, 
taking care afterwards to keep it condantly wet with 
the application. In mod indances cold water will anfwer 
every purpofe ; in others the aqua ammonias acetatx, or 
lotions of the fulphateof zinc, alum, &c. may be employ¬ 
ed. Poultices made with linfeed-meal and water, or with 
bread and water, are the ordinary applications of this 
kind ; and fo great is the importance which ought to be 
attached to the circumdance of making them foft and 
unirritating, that a furgeon of the firfl eminence has not 
difdained to make their compofition the fubjedt of partof 
a ledture before the College of Surgeons. With poultices, 
fomentations are alfo frequently proper, as having in all 
fevere cafes a great effedl in leflening the pain. Like- 
wife, when fuppuration is unavoidable, they accelerate 
the cure by promoting the formation of matter, and 
hadening its approach to the furface of the body. The 
common method is to dip flannels in a decodlion of 
chamomile-flowers, or white poppy heads, wring them, 
and apply them very warm to the inflamed part; but 
warm water anfwers the purpofe as well. In difcriminat- 
ing the cafes which require cold applications from others 
to which warm ones are mod ferviceable, the pradlitioner 
fhould always bear in mind, that, when fuppuration is 
inevitable, it is invariably mod advantageous to difcon- 
tinue cold allringents without delay. In general where 
the chance of the phlegmon being refolved is great, cold 
applications are bed ; but for the mod part the choice of 
the topical remedies mud be regulated by the patient’s 
feelings. There are fome patients who feem to derive 
mod eafe from hot applications ; there are others who 
appear to experience mod comfort from cold ones. The 
latter remedies ought perhaps rather to have the prefe¬ 
rence, when the profpedl of preventing fuppuration is 
fair and rational, and when at the fame time they afford 
as much eafe as poultices. There are feven fpecies. 
1. Phlegmon communis : tumour common to the fur¬ 
face ; bright-red; hard; defined; hemifpherical; pola¬ 
rized ; gradually foftening and burding at the pole. 
2. Plilegmone parulis, gum-boil: tumour feated on 
the gums; deep red ; liardifh ; undefined; pain obtufe. 
Divided into two varieties. 
as. Simplex : limited to the fubflance of the gums. ( 2 . 
Cariofa: connedled with a caries of a tooth or focket. 
When the former variety happens, the part may be freely 
opened with the lancet, and the gum fomented. When 
the latter variety comes on, the offending tooth mull be 
drawn. 
3. Plilegmone auris, impoflhumein the head : tumour 
feated within the ear; pain acute, throbbing; heat and 
rednefs fpreading externally; hearing diftreffingly keen, 
or dunned with imaginary founds; abfcefs burding with 
the fenfe of a loud fnap or explofion. In this complaint 
we fhould iyringe the infide of the ear with foap and wa¬ 
ter, and apply a blifter behind it. A roafled onion, though 
an anile prefcription, will alfo be found ufeful: it is ap¬ 
plied in the helix of the ear as a poultice. 
4. Phlegmon parotidea, phlegmon of the parotids: 
tumour feated under the ear: reddifli ; hard; pain ob¬ 
tufe; fuppuration flow and difficult. Two varieties. 
a. Benigna : incarnation and cicatrization regular and 
obflrudled. 
| 3 . Maligna : pus illaudable, profufe, protradled ; fuc¬ 
ceeded by foul Houghs. Dr. Parr gives the following 
account of this fecond variety. The malignant parotid 
(wells 
