6m

SURGERY.

tomatous. Sometimes, however, they are found to be replenishedwith a fluid lymph coagulable by heat, and are then called hyda-tids. One set are tilled with matter like the synovia of the joints,and get the name of ganglions. Tumours of this kind are easilydistinguished from all others, as having neither heat, pain, norpulsation, as is to be observed in those which incline to suppurate ;and they are distinguished from each other, before they are laidopen, by fluctuation being readily perceived in the meliceris : theatheroma is soft and compressible, but has no fluctuation; whiletlie steatoma is commonly firm, and rolls under the skin. Butthese rules are liable to considerable exceptions. The melicerisand atheroma, are most commonly found upon the head, and thesteatoma upon the other parts of the body ; while ganglions are si-tuated over the tendons of the muscles. These tumours must beeither extirpated entirely, Or laid open so as to dispose the cyst toslough off'or granulate. If the matter be fluid, we may evacuateit by an opening made with a lancet, or by means of a seton ; butas the matter is apt to collect again, it is better to remove the sacentirely. If large vessels or nerves prevent this from being done,then it is to be laid freely open and exposed to the air, so that thebag may granulate, or be thrown off. When the tumour is to beextirpated, a longitudinal incision is to be made through the inte-guments ; after which the tumour maybe frequently removed bythe point of the finger, or by the end of a spatula, replacing the in-teguments with a view to heal by the first intention. In everypendulous tumour of this kind, with a narrow neck, we ought todivide the teguments near the bottom of the tumour, in an ovalform, so that the wound may be afterwards properly covered withthe remaining integuments. After the tumour is removed, theskin is to be replaced over the wound, and fixed with adhesivestraps, covering it with a pledget of cerate, a small compress oflinen, with a bandage above all, to make a gentle pressure on theparts.

Of Scrophulous Tumours.

In the treatment of scrophulous tumours, some practitioners ,have recommended poultices, &c. to bring them to suppuration ;but the best practitioners have laid them aside, because they in-crease the soft and spongy state of the parts, by which they arekept from healing. As external applications are ineffectual, it isbetter to allow scrophulous tumours to be as much exposed as pos-sible, as this frequently renders the subsequent ulcer more easily■cure^J. The other methods recommended for discussing these tu-mours are, the internal use of cicuta, burnt sponge, muriated ba-rytes, a long continued use of the cold-bath, particularly of sea-bathing, and drinking mineral or sea-water. These, to produceany effect, should be begun early, while tumours are small, andlong persisted in. When the tumours come to a state of suppura-tion, if they are seated upon the thorax or abdomen, or any of thelarge joints, free vent ought always to be given to the matter toprevent its bursting into these cavities; and when the abscess islarge, this should be done with a trocar, or by passing a cordthrough it to exclude the external air. When the tumours are notsituated upon great cavities, it is better to allow them to break ofthemselves, as the sores commonly heal more readily, and the scaris pretty similar in both. The most proper applications to scro-phulous sores seem to be those of the suturine kind, as they dimi-nish inflammation, and in some measure prevent the sore fromspreading.

Polypi are pendulous, fleshy, indolent, tumours, so called fromtheir supposed resemblance to the animal of that name. Theymay be found in different cavities of the body, and originate fromthe lining membrane ; but those which come under surgic; I treat-ment are found in the nose, mouth, throat, and outer passage ofthe ear, and in the vagina and rectum. 'They are divided into twoclasses ; the one soft and compressible, the other extremely firm.Both of them bleed on being fretted or roughly handled. Thesoft kind shrivels and contracts in a dry atmosphere, (this is parti-cularly the case with those of the nose ;) but the firm are not af-fected by the weather. Their colour is commonly pale and trans-parent, and sometimes a deep red. As long as they remain sta-tionary, they are not to be touched; but when they continue togrow, we ought to use astringent remedies, especially a strong so-lution of alum, a decoction of oak-bark, vinegar, ardent spirits,&c, 'Hie softer kinds of polypi may frequently be prevented for

a long time from increasing in size, and sometimes they even be-come considerably smaller. Mercury has been found rather tomake them woise; caustic and other corroding applications havebeen of use in the softer kind, though they have not produced acure. Setons have likewise been used with little advantage. Itis therefore found necessary to have recourse to a more etiectualpractice; and with this view the knife, seissars, forceps, or liga-ture, are more generally recommended. The knife and seissarsmay be used when the roots of the tumour can be readily comeat; but polypi are seldom so situated as to render excision practi-cable; and even when they are, the hazmorrhagy may lie attendedwith considerable danger. " The removal of a polypus by tearingor twisting it with the forceps, (Plate CLX1V. fig. 5,) is occasion-ally practised ; but as ligatures are less painful, and fully as effec-tual, they are now more generally employed. The ligatures con-sist of wire, catgut, silk-cord, &c. Different methods have beenemployed for passing these over polypi, according to their differentsituations. When the ligature is to be applied, it is to he passeddouble over the tumour, and conducted to the root of it by meansot the fingers, or by slit probes, as in fig. 0 , or rings, fig. 7 , as maybe best suited to the shape and size ot the passage. The ends ofthe ligature are then to be introduced into a single or double ca-nula/ as in fig. 8, which is to be pushed along the opposite side ofthe polypus till the end of the canula reach the root of it, whenthe ligature is to be drawn somewhat tight, and fastened to the ca-nula which is to be left in the passage. The ligature is to be dailytightened till the tumour drop off. In this manner the largest po-lypus may lie removed equally well with those of a smaller size.Should any part of it remain, it may he destroyed by caustic, anddifferent instruments are contrived for conducting this to the rootof the tumour.

Of Diseases of the Bones.

Tlie bones as well as the softer parts are liable to be swelled,either throughout their whole length, or to have tumours formedon particular parts of them.

Txostosis is one species of tumour of the bone. According toMr. liromeiieid, no swelling should be called so, but an excres-cence continued from a bone, like a branch from tlie trunk of atree. Under this head, therefore, is ranked tlie benign node,which may be produced .by external injury, such.as contusions andfractures: it can hardly be called a disease, as pain seldom suc-ceeds, but rather a deformity.

There are risings or tumours observable on the bones, whichare often the consequents of venereal virus, and are termed tophi,guiimii, or nodes. Tophus is a soft tumour in the bone; andseems to be formed of a chalky substance, that is intermediate be-tween the osseous fibres. These cretaceous extravasations aresometimes found on tlie ligaments and tendons, as well as on thebone; and may sometimes betaken out by the knite. We havemany instances where chalk-stones in gouty people make their wayout through the skin of the fingers and toes.

Gummi is a soft tumour on the surface of the bone, between itand the periosteum ; and its contents resemble gum softened, fromwhence it has taken its name. A bone may become carious firstiu its internal parts; and that Irom external injury, as well as fr<»n*a vitiated state of tlie animal-fluids. Authors seem not to agree asto the technical term for this kind of disease of (he bones; somecalling it cancer, or gungrxna ossis; others, spina ventosa, fromtlie pointed extuberances usually attendant on this disorder of thebone; and some again teredo, from tlie appearance of the cariousbone like wood that is worm-eaten. It is universally allowed*that this disease takes its rise from matter being formed either inthe diploe, or in tlie marrow : whenever obstruction is begun inthe vessels expanded on, or terminating in, the medullary cysts*the consequence will be inflammation, and, if not early removed,matter will form ; for tins reason this case may be called abscessesin medulla. Whenever, then, a patient complains of dull heavypain, deeply situated in tlie bone, possibly consequent to a violentblow received on the part some time before, though the integu-ments appear perfectly sound, and tlie bone itself not in the lea»tinjured, we have great reason to suspect an abscessus in the me-dulla. Children of a bad habit of body, though they have notsuffered any external injury, will often become lame, and com-plain of tire limb being remarkably heavy; and though not