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Gen. I. the deceptive manner of its attack, medical advice, and Spec. II.

particularly a free use of purgatives and the lancet, which Apostema psoaticum. might have been of essential service at first, is fatally Psoas ab

postponed; and the symptoms are regarded as those of Abscess may an accidental strain. After the abscess is formed, howdischarge ever, the pain, in most cases, increases considerably; itself by different and the matter may be discharged into the cavity of the outlets.

abdomen, where it would soon be fatal. On this account, it obeys the law of instinct we had lately occasion to notice; follows, in most instances, the course of the psoas muscle, and points externally a little lower than the inguinal glands; or it passes down the thigh, where, however, it is apt to dissever the muscles and form sinous abscesses. Sometimes, though rarely, the matter passes through the muscles of the back, and is discharged in the

loins; and in a few instances it has been known to fall Highly into the cavity of the back part of the pelvis. The abdangerous : scess, therefore, is highly dangerous; since under the

most fortunate circumstances it is so long in pointing ex

ternally, even if it should make any visible pointing at and often all, that the patient usually sinks under a hectic fever, productive produced by the local irritation. While in most cases, hectic. in which it has made a natural opening for itself, it has

been found connected with so many deep sinuses, which

cannot be followed up, that the same effect ensues. Medical

No mode of medical treatment has been found protreatinent rarely of

ductive of any good purpose; and the cause has been, in a very early stage of the suppuration, given over to the surgical practitioner. Yet even here different individuals have pursued different lines of conduct. Mr. Bell ad

vises an early evacuation of the matter, lest the bones Surgical should become injured; while Mr. Abernethy appretreatment discrepant.

hends less danger from its being suffered to remain, and at last evacuates it at different intervals, and by successive operations : by which means the cyst, in which the pus is principally lodged, may have an opportunity of contracting; and this, he thinks, it has a greater tendency to do than in abscesses where the inflammation is more violent. He is also attentive to close the opening the

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instant the matter is discharged, so as to prevent any in- Gen. I. crease of the inflammation by an access of air.

Spec. II.

Apostema The real cause of danger does not seem to have been psoaticum. hitherto hit upon; but it may probably be referred to

scess. that tendency to a rapid spread of inflammation over Sugger their entire surface, which Mr. Hunter has shown to ex- as to the ist in all internal cavities, and the hazard of which is in read anuger proportion to the extent of the cavity; a subject already touched upon in the discussion of puerperal fever, and which we shall have other opportunities of illustrating as we proceed, particularly in some cases of varicose enlargement of the veins. Now in the disease before us we have not, it is true, any natural cavity, but we have an artificial cavity of long standing, and large extent, in a highly irritable state, and which is therefore peculiarly predisposed to run into all the fatal effects of large natural cavities, when injured or otherwise rendered imperfect. The author throws out this hint, however, for future and general consideration.



Abscess of the Liver.



This is also a very fatal disease; and usually terminates GEN. I. in one of the following ways :


Terminates Firstly, The substance of the liver is gradually and variously. almost entirely absorbed from long continued irritation : Extensi

absorption the melancholy accompaniments of which are a tedious of the liver. icterical marasmus, hectic fever, great anxiety, and a sa

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Gen. I. nious and fetid diarrhoea, which is the forerunner of Spec. III. death. Apostema hepatis. Secondly, The abscess breaks internally and disAbscess of ohore the liver.

charges a sanious pus into the belly; by which means The apo the rest of the viscera are affected ; and the terminatton steme may is marasmus, ascites, and dissolution. open into the cavity

Thirdly, The pus sometimes finds a passage into the of the ab- biliary ducts, and thence into the intestines; from these domen.

it is occasionally thrown into the stomach and vomited in The pus may find a the form of a dark offensive material : but far more gepassage in- nerally it is carried downward and produces a violent to the intestines.

looseness. Acids and acescent medicines may here pal

liate for a time; but the issue is always fatal. The apo Fourthly, The enlarged liver becomes, in some cases, steme may

united by adhesive inflammation to the peritonæum, and ternally. the abscess opens externally; and, in this case, there is

a chance of cure. The opening should be expedited by a caustic or the knife : and the cure will greatly depend

upon the nature of the fluid which is discharged. The pus Fifthly, There is reason to believe that in a few rare may be car

. instances the matter is carried off by absorption, when a

healthy granulation takes place, and a cure is completed by absorbtion.

without any opening. This termination is more reasonably to be expected in a constitution otherwise sound, and where the liver has not been weakened or rendered torpid by any former affection. It is hence rather to be looked for in a temperate than in a tropical climate, and

in youth than in advanced life. Often a These cases may, indeed, be regarded as sequels of sequel of

hepatitis; though it is possible that pus may be thrown hepatitis.

into the penicilli and biliary pores of the liver by a metastasis from some other organ, as it not unfrequently is

into the tubules of the kidneys, and thence conveyed to easy to de

Set the bladder. When the cure takes place without an tect pus opening, it is not always an easy matter to determine for opening.

a certainty that pus has actually been formed. But Yet the sometimes we can trace a fluctuation; and at other times symptoms the subsidence of the tension, pain, and pulse, after one often sufficient to or two severe shivering fits, may be regarded as suffidecide.


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cient indications. In a case of this kind that occurred Gen. I. to me in a young gentleman of about thirteen years of

Apostema age, the shivering was so considerable as to make the hepatis. teeth chatter; and within eight and forty hours the

the liver. pulse sunk from a hundred and forty to a hundred and twenty; and the abdominal tension and tenderness were considerably abated; as was also the distressing cough with which he had almost perpetually been harassed for some weeks. He was put upon a tonic plan of columbo and sulphuric acid immediately after this change, and recovered gradually. .



Lodgement of Matter in the Chest.




To the symptoms enumerated in the above definition Gen. I. Hippocrates adds*, edema of the feet, hollowness of the SS

Symptoms eyes, and a gurgling sound on shaking the shoulder. noticed by Of these additional signs, the first two belong rather to

Hippothe hectic fever that generally accompanies empyema, than to the disease itself. The last has sometimes been met with in modern timest. Dr. Cullen regards em- Not always pyema as a mere sequel of pneumonia, which with him

pneumonia includes inflammation of the pleura, as well as of the as pre

sumed by

Cullen. • Msed Ileti, pp. 476, 496. + Trecourt, Mémoires de Chirurgie, &c. •

the chest.

Gen. I. lungs, but as it may take place from inflammation of the Spéc. IV. Apostema

mediastinum, pericardium, or diaphragm, to say nothing Empyema of that from external injuries, and as it is often doubtful. Lodgement of matter in

what particular organ is directly injured, a separate spe- : cies seems decidedly called for. Goekel, indeed, ders. scribes a case in which the pericardium was affected in connexion with the right lung, and to such an extent

that both were totally consumed. .. Most fre- Most frequently, however, an empyema is produced duced by

pro- by the bursting of a large vomica of one of the lungs, the bursting into the cavity of the pleura. In which case the cough of a vomica.

becomes more frequent than before this result, and is either dry, or accompanied with a scanty, frothy, and noisy expectoration. The breathing becomes extremely difficult, with repeated fainting fits, and the dew of a cold, sweat hanging over the throat and forehead: the cheeks and lips are of an ominous red, while the nails are livid, the pupils dilated, and the sight dim. Death usually suca

ceeds to the rupture of the aposteme in a few hours. Diagnostics If percussion or the stethoscope be employed, before

* the vomica has broken, to the part in which the mat, the stetho- ter is seated, little or no sound will be returned in con-, scope.

sequence of the pressing fulness which exists there; but if these methods be resorted to afterwards, it will be found restored in a considerable degree to the part affected from the hollowness which now exists there, while it will be comparatively found diminished in the posterior and inferior parts of the chest to which the discharged load is transferred. For the history and relative value of these diagnostics the reader must turn to the treatment of Phthisis in the ensuing volume * 'yo

In some instances, however, there is no organ to which always to be referred

the pus can be referred as a process of ulceration; and to any par- to such an affection Mr. Hewson has several references.

“ The cavities of the pleura, pericardium,” &c. says he, « are sometimes observed to contain considerable quantities of pus without the least marks of ulceration. In


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sion and

Pus not

ticular argan.

• Vol. 11. Cl. 111. Ord. sv. Gen. 111. Spec. v.

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