MEDICAL

ABDOMEN.-Fig. i. and ii. The abdomen, or belly, the largest cavity of the body, is

and abdominal muscles. To facilitate description, medically, the abdomen is mapped out into regions by imaginary horizontal and vertical lines drawn as represented, fig. i. The horizontal lines drawn round the abdomen divide it into three zones, which, by the vertical lines, are divided into nine anterior regions, as follow:-1, Epigastric; 2, Umbilical; 3, Hypogastric; 4 and 5, right and left Hypochondriac; 6 and 7, right and left Iliac; 8 and 9, right and left Inguinal. In the upper zone lies the liver, fig. ii., 1, extending from under the

bounded above by the chest, fig. ii., 7; and below by the pelvic bones, which are joined in front, fig. ii., 8. These bones, which every one may feel in their own person, like. wise enclose a cavity-the cavity of the pelvis -which is sometimes described separately from the cavity of the abdomen; but the two are so completely undivided, that they are better treated of together. The cavity of the abdomen is divided from that of the chest, by the midriff or diaphragm; fig.ii., 6; posteriorly, it is supported and protected by the spine-it is inclosed by the short ribs

Fig. ii.

right ribs across to the left; the stomach fig. ii., 2, has its small end situated in the

epigastric, its large end in the left hypo chondriac region, where it is in contact with the spleen, or milt. The pancreas, or sweetbread, lies behind the stomach. The middle zone contains the large bowel, fig. ii., 3, the omentum, or caul, a portion of the small intestines, fig. ii., 4; and, posteriorly, lying close to the spine, the kidneys. The inferior zone also contains, centrally, a portion of the small intestines, laterally, the extremities of the large intestines or colon, and when it is distended, the superior portion of the bladder. All these parts, or viscera, are covered, and supported, by a smooth, glistening, moist membrane, the peritoneum, which is also continued over the parts within the cavity bounded by the pelvic bones. These are, more especially, the bladder, and terminating extremity of the bowels, named the rectum, and in the female, the womb, and its appendages. Both bladder and womb, when distended, rise from their own proper cavity into that of the abdomen. The viscera of the abdomen are divided into solid and hollow; of the former, the liver is an example; of the latter, the intestines and bladder. These, of course, give different sounds, when the covering of the abdomen, beneath which they lie, is slightly struck with the finger, a fact of great importance to the physician, in his examination of this cavity. The contents of the abdomen shift their position considerably according to posture. The diseases to which they are liable will be noticed under their respective heads. One of the most important accidents to which this cavity is subject, is protrusion of a portion of its contents through its walls, constituting hernia, or rupture. Accidental wounds penetrating the cavity of the belly are very generally fatal, and if they pierce any of the viscera, almost necessarily so.

Refer to-Diaphragm-Liver-StomachIntestines-Hernia.

ABLUTION.-Washing the surface of the body regularly, is, happily, in this country at least, becoming daily more common, but it is far from being so general a habit as it ought, particularly among the workingclasses, who stand most in need of it; many go from January to December without even thinking it necessary to wash more than the face or hands. The skin ought continually to be throwing off, or excreting, gaseous, saline, and greasy matter, which it is necessary for the health of the body to be thrown off; but the skin cannot do this properly if caked over with perspiration and dirt, either its own, or the dust to which many are exposed in the performance of

their employments. The consequence of neglect is, that much is retained in the system which ought not to be there; an additional load of duty is thrown upon other excreting organs, as the liver and kidneys, and if they have not the power to compensate for man's own carelessness, languor, low spirits, headaches, local accumulations of blood, gout, gravel, and other diseases are the result. Fortunately, complete neglect cannot entirely stop the skin's functions, otherwise death itself must result. For the purpose of cleansing the skin, soft water ought to be used, if possible, with soap-good brown is quite the most effectual-and a thorough purification of the entire surface of body should be effected once a week, at least, with these materials; along with this, washing over the surface with simple water, and rubbing well with a rough towel, every night or morning, as most convenient, will suffice to preserve a healthy state of skin. Those who are robust, and wash in the morning, ought to use cold water immediately on rising, while heat is abundant; but delicate persons cannot sustain the depression and subtraction of animal heat, which this occasions, it leaves them chilled, languid, and with impaired digestion. There are some individuals, in whom cold sponging in the morning, invariably produces heart-burn and indigestion after breakfast; such ought to try the water slightly warm, or content themselves with washing only a portion of the skin each morning; if even this cannot be borne, dry friction with a rough towel or hair-glove, may be substituted. After washing, it is always desirable to rub the surface thoroughly with a towel till a warm glow is produced. For washing at night, water slightly warm is always to be preferred. The feet require very frequent washing. It is surprising how insensible, even otherwise, respectable individuals are upon this point, were it not so, they would never expose themselves to medical men in the disgusting state of dirt they frequently do. Happy are those who can have the use of baths for the purposes of ablution, but any man who can command water and a towel, need not dispense with the luxury. For the aged, frequent and thorough ablution is most requisite, the, often, shameful neglect of this by those who have the care of old people, is visited upon them in querulousness, and troublesome bodily ailments, which attention to the duty would have prevented.

Refer to Bath-Children-Skin. ABORTION-MISCARRIAGE.-The terms abortion and miscarriage, are applied to

he expulsion of the human foetus from the womb of the mother, previous to the seventh month of pregnancy, that is, before it is sufficiently developed to maintain its own independent existence; when the process occurs after that period, it is named premature labour. Miscarriage involves pain and weakness, in addition to the loss of offspring, and is often a severe trial to the maternal constitution. It may occur at any period of pregnancy, but particular stages are more liable to the accident than others; these are generally considered to be about the time of the first menstruation after conception : again at the twelfth week, and towards the seventh month; the liability is increased at those times, which correspond to the menstrual period. When abortion has once taken place, it is more liable to occur again, and some have so strong a tendency to it, that they never go beyond a certain stage, at which they invariably miscarry. The cause of abortion may exist in the constitution of the female herself, and be the result of weakness and irritability, of over full habit, or of a diseased condition of the womb; the foetus may die, or be deficient in development, when it is cast off like a blighted fruit. Suckling after conception has taken place, is not unfrequently a cause of miscarriage. Active disease occurring during pregnancy, such as severe inflammation, fevers, eruptive fevers, &c., are almost certain to occasion expulsion of the uterine contents. Continued diarrhoea, and the action of strong purgatives, particularly of the aloetic kind are dangerous. This is a very cogent reason, for those who are pregnant, avoiding all quack aperient medicines, they almost all contain aloes, and may be very injurious. All undue exertion or agitation of body or mind, sudden jerks or jumps, riding on horseback in the early, or in a shaking carriage in the later stages of pregnancy, may any of them bring on the mishap; to these may be added, exertion of the arms in doing anything on a level above the head; costive bowels and straining consequent thereon, sensual indulgences, and luxurious habits. Those who have once aborted ought to be extra careful in succeeding pregnancies, and all ought to bear in mind the possibility of the occurrence. The symptoms of threatened abortion vary with constitution; in the strong and plethoric, it is often preceded by shivering and febrile symptoms, and by feeling of weight in the lower bowels; in the weak, there is languor and faintness, flaccidity of the breasts, and general depression, and pains in the back and loins. Intermittent pains, and

discharge of blood from the passage, tell that the process has begun. If miscarriage occurs within the first month or two after conception, the process may be accomplished with so little inconvenience as to escape notice, and to be mistaken for a menstrual period; more generally, however, the severity of the pain, and unusual clotted discharge, render the case evident. The pain, the discharge, and at the same time the danger of an abortion, are in proportion to the advancement of the pregnancy. When miscarriage goes on, the pains increase in force and frequency, and continue with discharge of blood, fluid, or in clots, until the ovum is expelled, after which, both become moderated, till they cease altogether, and the red flow gives place to a colourless one. It is very important that those in attendance upon the patient should examine every clot which comes away-if large, tear it in pieces-that they may ascertain whether the contents of the womb are expelled or not, for there is no safety or rest where miscarriage is progressing, till this has taken place, and everything cast off. When a medical man is in attendance, and in such cases he ought to be, all should be reserved for his inspection.

As soon as a female experiences threatenings of abortion, she ought at once to retire to bed, upon a mattress, and keep perfectly quiet till every symptom has disappeared: sometimes this simple measure, promptly adopted, is sufficient to avert the threatened evil. If there is much feeling of fulness, and the patient is of full habit generally, eight or a dozen leeches may be applied to the lower part of the bowels; if there is fever, salines may be given, such as the common effervescing draught of carbonate of soda and tartaric acid, or lemon juice; or if the bowels are much confined, seidlitz powders, assisting the action by cold clysters if necessary. When the pains are severe, particularly in the weak and irritable, twenty or thirty drops of laudanum should be given, and may be repeated in a few hours if the symptom is unabated. In the case of profuse discharge, the patient should be kept very lightly covered, movement avoided, and every article of food or drink given cold, iced, if possible, provided the vital powers are not excessively reduced; cloths dipped in cold or iced water should be applied to the lower part of the body, and frequently changed; acid drinks, with cream of tartar, may be given freely. Ten or fifteen drops of diluted sulphuric acid, or of aromatic sulphuric acid, may be given in a wine-glassful of water every two or three hours. Should slight faintness come

on, it is better not interfered with, it may be salutary; if it goes to an extent to threaten life, stimulants, sal volatile or brandy-and-water must be had recourse to. But long before matters go to this extent, proper medical assistance should be sought. Profuse and continued discharge, though it may not threaten life, must occasion weakness which is long of being overcome, and which may ultimately favour the development of fatal disease. The discharge may be kept up, solely, by a state of matters beyond the offices of domestic management, but to be speedily rectified by a little manual interference on the part of the medical man, who, by assisting the womb to cast off the already partially expelled contents, at once puts an end to further loss of blood. But even if matters be not sufficiently advanced to admit of this interference, the use of measures or remedies which the unprofessional cannot or ought not to employ, may save life, must save strength. Let no one think lightly of loss of blood, it saps the foundations of health. Circumstances may occur in which medical assistance is not to be obtained, at least not speedily, and flooding is profuse, and uncontrolled by the means already mentioned; in such a case, one grain and a half of sugar of lead made into a pill with crumb of bread, may be given every two hours, and washed down with a draught of vinegar and water, to which, if there is much pain, from five to ten drops of laudanum are to be added; in addition, pieces of linen or calico, soaked in a strong solution of alum, or decoction of oak-bark, and oiled, are to be used to plug the passage, or the astringent fluid may be thrown up with a syringe. It is repeated, the unprofessional should never adopt these measures, if professional advice is to be had, if not, it is better they should do so than matters go on uncontrolled. Both during the time, and after miscarriage, the general strength must be supported; this is better done by strong animal soups, milk-preparations, with eggs, and meat, when it is proper, than by much stimulant; nevertheless, wine or malt liquor may be requisite. Convalesence is to be assisted by tonic medicines, those containing mineral acid, bark, or iron, are generally the most appropriate. The bowels, as indeed they do throughout, will require attention. Castoroil is very suitable; the cold or very cool water clyster is most useful: a drachm of Epsom salts, dissolved in half a pint of water, either cold or slightly warmed, and fifteen drops of dilute sulphuric acid added, forms a most appropriate aperient which should be taken before breakfast.

Three principles of treatment are to be kept in mind in the management of miscarriage.

The first, to prevent it, if possible, by rest, opiates, &c.

The second, to allay pain; to moderate the discharge of blood; save and support strength.

The third, when abortion must take place, to expedite the separation of the ovum.

The two first may be much assisted by judicious domestic management, the third must be done by the medical attendant only. Refer to Pregnancy-Hæmorrhage. ABRASION.-An Abrasion, by which the outer or scarf skin, or cuticle, is forcibly removed, and the sensitive surface of the under true skin or cutis exposed, is a trifling, but sometimes a painful accident, and it may be, where the hands are necessarily subjected to the action of poisonous or irritating fluid, a dangerous one. The protecting cuticle is quickly restored, in the meantime it is necessary to provide a substitute. It must be an unirritating one. Persons often err by putting the common diachylon-plaster, on abrasions, and frequently much irritation and pain, and sometimes ulceration is produced by it. Court-plaster does not irritate, but is not useful for a large surface, in which case, gold-beater's leaf is quite the best application, if not exposed to moisture. Collodion has been used of late; it is not soon acted upon by water, but it causes severe smarting when first put on; this may be prevented by putting gold-beater's leaf next the sore, and collodion over. In the absence of the above, a little strong gum mucilage with a piece of tissue paper over, is a good substitute, Isinglass plaster is used; those who are not in the habit of applying it, find a difficulty in making it adhere. The principle in treating an abrasion, is to protect the sensitive true skin by some light, perfectly unirritating, dry application, till nature restores the natural covering.

Refer to Collodion-Plasters-Skin,

ABSCESS.. A collection of purulent fluid in a cavity, formed in the substance of any of the bodily tissues, is named an abscess. The contained matter, or pus, may be either of a healthy or of an unhealthy character; if the former, it is of a yellowish white colour, cream-like in consistence, and possesses a faint sickly odour; in the latter case, it may resemble whey, with bits of curdy substances floating in it, or it may be bloody, fetid, &c.

Abscesses are either acute or chronic, and may occur in nearly every tissue of the body. The first symptoms of an acute ab