GEN. I. SPEC. V. Apostema Vomica. Vomica. Patient sometimes flattered

taken place, and pus is secreted, the irritability frequently subsides; the pulse improves, the febrile exacerbations are less frequent and violent, and the patient flatters himself he is recovering. The vomica at length bursts and disabuses him; he sinks gradually from the quantity of the daily discharge, and the confirmed hectic; or, if the disease be seated in the lungs, and the cavity extensive, he may be suffocated by the volume of pus that Sometimes overwhelms the trachea.

into a false

hope of

recovery.

suddenly suffocated.

Singular

Bartholine gives a singular case of an occult vomica of the lungs, that, accompanied with an asthma, procase of cure. duced great emaciation; but was fortunately cured by the wound of a sword, the point of which passed between the ribs and opened the sac. A considerable flow of pus followed, and the patient recovered gradually from the time of the accident*.

Application of the me

thods of percussion and

auscultation.

The methods of percussion and mediate auscultation are now very generally resorted to on the continent and occasionally in our own country to ascertain the existence and extent of this affection when seated in the chest; the theory and employment of which the reader will find explained at some length, under the treatment of PHTHISIS in the ensuing volume +.

Hist. Anat. XIV. Cent. 6.

+ Vol. II. Cl. III. Ord. Iv. Gen. ш. Spec. v.

GENUS II.

PHLEGMONE.

Phlegmon.

SUPPURATIVE, CUTANEOUS TUMOUR; TENSIVE; GLA-
BROUS; PAINFUL; AT LENGTH FLUCTUATING, AND
BURSTING SPONTANEOUSLY; THE PUS UNIFORM AND
GENUINE.

GEN. II. character of

General

UNDER the last genus we took a general survey of the process and economy of suppuration, and noticed many of the most extensive and dangerous forms in which phlegmon. suppuration ever presents itself. We are now advancing to inflammatory affections, consisting of tumours of small extent, and either entirely confined to the integuments, or dipping but a little way below them.

by the

modern

The term phlegmon, from oxéyw, "inflammo", was In what used among the Greeks for inflammation generally. It sense used has long since, however, been employed in a far more Greeks; limited sense by medical writers of perhaps every school, loosely emthough few of them have given a very clear definition of ployed in the exact sense in which they have intended to use it; times: or perhaps have formed such a sense in their own minds. Thus Dr. Cullen makes it comprise a multitude of tu- by Cullen; mours or tubercles of different degrees of inflammation, some suppurative, some unsuppurative, some serous, some callous, some fleshy, some bony; as boil, minute pimple, stye, stone-pock, abscess of the breast, and spina ventosa, or carious bone; with many others altogether as discrepant; while by Sauvages it is limited, and far by Saumore correctly, to spheroidal tumours, possessing red- vages; ness, heat, tension, violent throbbing pain, spontaneously suppurating. Not indeed, essentially different from the character now offered, and involving most of its species.

Vogel, however, makes it a part of its generic character by Vogel;

GEN. II. Phlegmone. Phlegmon.

that the inflammatory tumour, in order to be a phlegmon, must be at least as large as a hen's egg; while Dr. Turby Turton. ton, in his useful glossary, not knowing how to reconcile

More correct mean

ing.

the clashing descriptions which are thus given of it, merely explains it after the Greek manner "an inflammation", leaving the reader to determine the nature of the inflammation according to his own taste.

It is necessary, therefore, to come to something more definite; and I believe that the character now offered embraces the common idea of phlegmon; or, if not, will propose what should seem to form a boundary for it. And thus explained, it will comprise the following species:

GEN. II.

SPEC. I.

SPECIES I.

PHLEGMONE COMMUNIS.

Push. Common Phlegmon.

TUMOUR COMMON ΤΟ THE SURFACE; BRIGHT-RED;
HARD; DEFINED; HEMISPHERICAL; POLARIZED; GRA-
DUALLY SOFTENING AND BURSTING AT THE POLE.

IN vernacular language this species is denominated a push;
and in size has a near approach to a boil, or furuncle;
but essentially differs from it in having its pus uniform
and mature, while that of the boil is always intermixed

GEN. II.

SPEC. I.

Push.

Common

How differs

from a boil.

General

with a core. It is commonly a mark of high entonic health, or a phlogotic diathesis; and rarely requires any Phlegmone other medical treatment than bleeding, or a few cooling communis. purgatives. Where, however, pushes appear in crops, and espe- phlegmon. cially in successive crops, they support a remark we had occasion to make in opening the present order; that in conjunction with the phlogotic diathesis there is probably character. a peculiar susceptibility of irritation; since we frequently find persons in the highest health, with firm and rigid fibres, pass great part, or even the whole of their lives, without any such affection as the present. Such susceptibility is far more common, indeed, to a habit of an opposite character, but it seems from this as well as from other circumstances, not unfrequently to inhere in the temperament we are now contemplating.

Habit in

which it

often occurs.

SPECIES II.

PHLEGMONE PARULIS.

Gum-Boil.

TUMOUR SEATED ON THE GUMS; DEEP-RED; HARDISH;
UNDEFINED; PAIN OBTUSE.

THIS is sometimes limited to the substance of the

gums;

GEN. II. SPEC. II. or General

and sometimes connected with a caries of a tooth socket. In the first variety it is a disease of only a few character. days' duration, and ceases almost as soon as it has burst or is opened in the second, it will often continue troublesome till the carious tooth is extracted, or the carious socket has exfoliated or the whole of its texture is absorbed; in which case the tooth will become loose, and may at length drop out spontaneously.

Swediaur tells us that he once saw this disease produced in a man, otherwise sound, in consequence of a

GEN. II.

SPEC. II.

suppression of an habitual hemorrhoidal flux, accomPhlegmone panied with a loosening of the wise and incisor teeth. In women he had frequently met with the same from obstructed menstruation*.

Parulis.
Gum-boil.

Suppuration to be encouraged,

mour soon

opened.

Gum-boils, and especially where connected with a morbid condition of the subjacent teeth, or their alveoli, rarely disperse without passing into the suppurative stage and hence the means of prohibiting this termination are usually tried in vain, much time is lost, and protracted pain encountered. For these reasons it is better to encourage than to repel the suppurative process, by warm cataplasms or fomentations; and to open and the tu- the tumour as soon as it begins to point. An early opening is of importance; for, from the toughness and thickness of the walls of the abscess, it is seldom that the confined pus obtains a natural exit with sufficient freedom; while in some instances the ulceration assumes a sinuous character, or works into the substance of the cheeks, and at length opens on their external surface. The worst and most painful gum-boils are those which form on the dentes sapientiæ; the swelling, from the violence of the irritation, spreads rapidly and widely; so that the entire cheek is sometimes involved in it, the neck indurated, and the eye closed.

Gum-boil, where severest.

GEN. II.

SPECIES III.

PHLEGMONE PAROTIDEA.

Parotid Phlegmon.

TUMOUR SEATED UNDER THE EAR; REDDISH; HARD;
PAIN OBTUSE; SUPPURATION SLOW AND DIFFICULT.

It is not a little singular that Dr. Cullen, who extends SPEC. III. the genus of phlegmone wide enough to embrace, not

Where ar

ranged by

Cullen.

Nov. Nosol. Meth. Syst. 11. 437.