SURGERY.

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conclude, that suppuration will take place; and should thereforeimmediately desist from such applications as were judged properwhile a cure was thought practicable by resolution, and endeavourto assist nature as much as possible in the formation of pus, or what iscalled maturation of the tumour. For this purpose there is nothingbetter than to preserve a proper degree of heat in the parts. Thisis commonly done by the means of warm fomentations and cata-plasms ; and when these are regularly and frequently renewed,nothing, it is probable, could more effectually answer the purpose.But in the ordinary manner in which they are applied, by the cata-plasms being renewed only once, or at most twice a-day, they mustalways, it is imagined, do more harm than good. For so soon asthe degree of heat they were at first possessed of is dissipated, themoisture kept up by them, with the consequent evaporation whichensues, must always render the part a great deal colder than if ithad been merely wrapped in flannel without the use of any suchapplication. To receive all the advantages of such remedies, thepart affected should be well fomented with flannels, pressed outof any warm emollient decoction, applied as warm as the pa-tient can easily bear them, continued at least half an hourat once, and repeated four times a day. Immediately after thefomentation is over, a large emollient poultice should likewise beapplied warm, and renewed every second or third hour at farthest.Of all the forms recommended for emollient cataplasms, a com-mon milk and bread poultice, with a proportion of butter or oil, isperhaps the most eligible; as it not only possesses all the advan-tages of the others, but can at all times' be more easily obtained.Roasted onions, garlic, and other acrid substances, are often usedas additions to maturating cataplasms. When there is not a duedegree of inflammation in the tumor, and when it appears proba-ble, that the suppuration would be quickened by having the in-flammatory symptoms somewhat increased, the addition of suchsubstances may then be of service; but when stimulants are ne-c essary in such cases, a small proportion of strained galbanum,0r of any of the warm gums, dissolved in the yolk of an egg,und added to the poultices, is a most certain form of applyingmem.

Matter being fully formed in a tumor, is known by a remis-?° n of all the symptoms taking place ; the throbbing pain, whichbefore was frequent, now goes off, and the patient complains of ab'ore dull, constant, heavy pain : the tumor points at some parti-c ular part, generally near to its middle; where, if the matter isbut encysted, or deep seated, a whitish yellow appearance is ob-served, instead of a deep red that formerly took place ; and fluc-tuation of a fluid underneath is, upon pressure, very evidently dis-covered. Sometimes, indeed, when an abscess is thickly covered"Uhl muscular and other parts, though, from concurring circum-^uuces, there can be little doubt of their being even a very con-.'herable collection of matter, yet the fluctuation cannot be readi-ly distinguished: it does not, however, often happen, that matters s p very deeply lodged as not to be discovered upon proper ex-amination. 1 his, however, is a circumstance of the greatest con-fluence in practice, and deserves more attention than is com-° r hy given to it. In no part of the surgeon’s employment isf perience in former similar cases of greater use to him than ine present; and however simple it may appear, yet nothing, it ist e . n > more readily distinguishes a man of observation and ex-nsive practice, than his being able easily to detect collections ofseated matter. After the matter is fully formed, and theg: Cess brought to maturity, the only remedy is to open it, andy.j.P to the pus it contains. In many cases, indeed, natureh u ,u° the work, and abscesses, when superficially seated, willbo St themselves; but where the matter lies deep, we are bymeans to wait for this spontaneous opening; as the pus will"hlq 6 an acr im°ny before it can break through the integuments,L 1 may prove very prejudicial to health. However, it is a{ a L er al rule not to open abscesses till a thorough suppuration hasPlace; for, when laid open long before that period, andlllo fmiy considerable hardness remains, they commonly provehow? tr ° l ‘blesome, and seldom heal so kindly. In some cases,0 p e , it is necessary to deviate from this general rule, and toahs t" Um a good deal sooner; particularly in all such criticalthes e as oc ? u r i n malignant fevers; as, from experience inm 0Va , r r<Iers ,.it ls f° un d to be of more consequence, for the re-°* t* 16 original disease, to have a quick discharge of matter

produced, than any harm the patient can ever suffer from having aswelling somewhat prematurely laid open. There are three waysof opening an abscess so as to give an outlet to the matter; bycaustic, by incision, or by the introduction of a seton. The firstis more agreeable to timid patients, who are afraid of the pain ofincision, but is attended with some inconveniences which renderthe method of incision much preferable. Caustic acts slowly, andproduces a long continued pain ; besides, no kind of caustic hasyet been invented, the effects of which can be confined to a cer-tain determinate extent; hence the patient is liable to suffer muchunnecessary pain, as the caustics commonly employed are eitherthe lapis infernalis or lunar caustic. 'File abscess is to have a slipof adhesive plaster'applied to it, with a slit cut in it of a size some-what less than the opening is intended to be. This slit is to betilled with caustic reduced into a powder, and wetted to make itact more quickly. It is then to be covered over with a plaster,and the whole is secured with a firm compress and bandage. Thetime necessary for the caustic to make a sufficient opening willdepend upon the thickness of the skin and strength of the caustic ;but generally it requires several hours. When we find that anesciiar is tiiade, it is to be softened with any emollient oint-ment until it can be readily separated ; after which, the mat-ter is to be discharged, and the abscess treated as one opened byincision.

The method of opening abscesses by the Knife is, to make anincision of such a size as to give free vent to the matter. Theopening is to be made in the under part of the tumor, that thematter may pass readily out. It has been a practice among sur-geons either to open a large abscess from end to end, or at leastthrough two-thirds of its length ; but from the bad consequenceswhich often attend this method, the latest practitioners havethought it better merely to give a free discharge to the matter,,without exposing the part to the action of the air. The thirdmethod, viz. that by the seton, is now frequently employed. Ithas the advantage of being attended with little pain, emptying theabscess in a gradual manner, and completely preventing the ac-cess of the air, which, in the other two methods, is often attendedwith bad consequences; and it frequently performs a cure in amuch shorter time. There are various instruments for introducingthe seton ; it may even frequently be done by a lancet and com-mon probe; but the instruments represented in Plate CLX1V.fig. 2 and 3, are more frequently employed. One of these beingthreaded with glover’s soft silk, is to lie introduced through theupper part of the tumor; but if the blunt one, (fig. 3,) be em-ployed, it will be necessary to have the assistance of a lancet; theinstrument is then to be brought out at the under part of thetumor, and in this way the matter will be allowed to run graduallyoff. The other consequence of inflammation is gangrene, whichmay terminate in mortification. When the colour of an inflamedpart changes to a dark red, when blisters arise on it containing anichorous fluid, we know that it has become gangrenous. When itbecomes black, llaccid, and insensible, when it loses heat, and ac-quires a putrid smell, it has proceeded to complete mortification^.A gangrene seldom affects those who enjoy a good habit of body,though even in them, it may be brought on accidentally by what-ever destroys the texture of a part; as contusion, long’continued.pressure, or whatever deprives a part of its nourishment. In likemanner, cold, by stopping the circulation, may produce gangrene,and frequently does so in cold climates. T his comes on sudden-ly, without any pain or previous inllammatioir, and the patienthimself is frequently insensible of it, till he is informed .of hissituation by some other person. A defect in the circulation,in extreme old age, frequently occasions mortification. in. theextremities.

There is another variety of the disease termed VV hitE Gan-grene; in which the parts supposed mortified do not turn black,but retain nearly their former colour, &c. 'W lielher such a com-plaint, however, can with propriety be denominated gangrene ornot, may properly be doubted' but as it is chietly that species ofthe disorder which succeeds inflammation that is here particularlytreated of, and in which no such varieties are ever observed, it isnot necessary to carry the inquiry farther.

The Prognosis in every case of gangrene is doubtful at first,as, even in the slightest cases, the patient may suffer from thespreading of the disease ; but slight cases, from external injuries,t are