were employed by his friends to encourage him, by advising him not to be afraid." By which good advice he conceived so much fear that he ran away early next morning, and returned in about a week quite well."

This should indicate that something may at times be accomplished by internal medicines, though no plan has hitherto succeeded that has been devised by professional skill.

Nor is the present the only case on record in which the contained fluid has disappeared by metastasis. It has passed off by the intestinal canal,* by the bladder, and by the vagina, in the form of pus; and is said in one instance to have vanished on the eruption of a scabies. It has also frequently passed off, by an opening formed by nature, and the patient has recovered his usual health. This opening has commonly been between the ribs, most usually between the third and fourth, but in one instance we find the abscess pointing and bursting under the scapula. Morgagni has recorded a singular case of a double empyema, a lodgement of pus being formed on both sides. And Balme a still more extraordinary case, in which the pus entered the cellular membrane and spread over almost the whole trunk.* **

When the fluid is discharged by paracentesis, Hippocrates urges repeatedly upon the surgeon to evacuate it only by degrees ;ff and Borelli gives a case in which the patient seems to have sunk and been lost under a sudden evacuation alone.‡‡ There has also been no small discussion concerning the part of the thorax to which the scalpel may be most advantageously applied. David, in his prize dissertation, advises near the sternum ;§§ Mr. Sharp between the sixth and seventh rib;|||| Mr. Bell wherever the pain or fluctuation may direct.¶¶

Mr. Warner, whose success made it many years ago a favourite operation in our own country, seems to have been of Mr. Bell's opinion, and varied the point of opening according to the nature of the case. And so little danger did he apprehend from the use of the scalpel on any occasion, that he not only evacuated in all instances

* Kelner, Diss. de Empyemate. Helm. 1670. Marchetti, Obs. 82. 89.

† Buchner, Diss. sistens solutionem Empyematis per mictionem purulentam, Hal. 1762. N. Act. Nat. Cur. Vol. 1. Obs. 5.

Schlichting, Phil. Trans. Vol. XLII. p. 70.

◊ Hautesierk, Recueil. 11. p. 239.

Hurten, Diss. de Empyemate. Argeat. 1679.

De Sed. et Caus. Morb. Ep. xxII. Art. 13.

** Journ. de Medicine, Tom. LXVI. p. 244.

†† Περι Νούσαν, II. p. 476. 1. 42. Περί των ενθος Παθων, Ρ. 536. 1. 15.

‡‡ Cent. I. Obs. 72.

4 Mem. pour le Prix de l'Academie, x.

Critical Enquiry, &c. Chap. VI.

11 Surgery, Vol. 11. 390.

the whole of the matter at once, but in one or two instances operated, where there was neither a polarized pain, nor fluctuation, nor visible discolouration, nor any external sign whatever, to direct him to one part rather than to another, or even to determine the real nature of the disease; otherwise than from the specific symptoms laid down in the preceding definition.

In Mr. Warner's cases, about twenty ounces of pus formed the average of discharge at the time of the perforation:* the patients usually found instant relief; the pain, cough, and quickness of pulse diminishing, and the breathing becoming easier. He dressed the wound with a sponge-tent till there was no longer any discharge, and afterwards superficially; and in about six weeks the patients were discharged cured. In this case it is perhaps more necessary to keep the wound open than in any other operation, since, till the ulcerated surface of the interior is completely healed, the secreted pus is apt to accumulate, and the operation must be renewed. Tents of all kinds are very properly exploded in most cases in the present day; but Mr. Bell has judiciously observed that in the paracentesis the old fashioned practice ought still to prevail.

Dr. G. Hawthorn has given an instance of this disease, that for its severity and danger, and particularly for its successful issue, is well worth recording. The patient was thirty years of age, and the disease had been brought on by exposure to damp night-air, in a state of intoxication. He suffered greatly from quickness of pulse, incessant cough, oppression, and dread of suffocation. A distinct fluctuation was perceived in about three weeks from the attack; shortly after which he was a little relieved by a discharge of purulent matter effused into the bronchial cells, and expectorated to the extraordinary amount of five or six pounds daily, for many days in succession, a fluid of an intolerably offensive smell, and putrid appearance. He continued, however, to grow worse and weaker; his feet and legs swelled; his countenance was ghastly and he had colliquative sweats. About twelve weeks from the attack the operation was performed, nearly twenty pounds of pus were discharged on the first day and night; and he gradually recovered.

Riedlin operated with success twice on the same person.§

The matter when discharged or examined on dissection has been found, as may be easily supposed, of very different consistences; sometimes pure pus, sometimes cheesy, and sometimes gelatinous. And the mischief to the interior of the chest has in some cases been very great. Several of the ribs have been found carious;|| the lung on

*See Phil. Trans. Vol. XLVII. XLVIII, LI. as also his works in their collected form.

+ Surgery Vol. 1. ch. XXII. Sec. IV.

Edin. Med. and Surg. Journ. No. LXI. p. 513.

Linn. Med. Ann. v. Obs. 30.

Heuermann, Vermichta Bemenhungen, 11. p. 217.

the affected side totally eroded;* and in one case the pericardium destroyed as well as the lung.f

SPECIES V.

APOSTEMA VOMICA.

Fomica.

DERANGED FUNCTION OF A THORACIC OR ABDOMINAL ORGAN; SUCCEEDED BY A COPIOUS DISCHARGE OF PUS INTO SOME PART OF THE ALIMENTARY CHANNEL; AND ITS EVACUATION BY THE MOUTH OR ANUS.

THE specific term is a derivative from the Latin vomo, "to eject," especially from the stomach, but not exclusively so; and hence, on the present occasion, it is used in the comprehensive sense in which it is employed by Celsus, who applies it to a bursting of pus from the liver, or any other large internal organ, as well as the lungs. Sauvages follows Celsus in this interpretation. Boerhaave and Cullen confine vomica to the lungs, and this in a more restrained sense than most writers; for they limit it to what has been called, though with no great accuracy occult vomica, "vomica clause." Linnéus and Vogel, on the contrary, while they confine the term to the lungs, explain it by open vomice "vomica apertæ," in which the pus is thrown forth profusely and suddenly. One termination of the hepatic aposteme may be regarded as a variety of this species, for, as we have observed, it sometimes issues in a discharge of pus by the mouth or rectum. Wherever it occurs, it appears to consist in a conglobate gland, first enlarged by a strumous congestion, and afterwards slowly and often imperfectly suppurating. Vomicæ vary in size, from the diameter of a millet-seed, to that of an orange. The smallest rarely contain any fluid, and sometimes not even a cavity; but they are often highly irritable, and maintain a very considerable degree of hectic fever. When ulceration has 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 overwhelms the trachea.

Kelner, Diss. de Empyemate. Helmst. 1670.

+ Goeckel, Gallicinium Medico-pract.

De Medicin. Lib. iv. Cap. viii.

Bartholine gives a singular case of an occult vomica of the lungs, that, accompanied with an asthma, produced 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.*

GENUS II.

PHLEGMONE.

Phlegmon.

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

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 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.

'The term phlegmon, from pasyw, "inflammo," was used among the Greeks for inflammation generally, It has long since, however, been employed in a far more limited sense by medical writers of perhaps every school, though few of them have given a very clear definition of the exact sense in which they have intended to use it; or perhaps have formed such a sense in their own minds. Thus Dr. Cullen makes it comprise a multitude of tumours 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 more correctly, to spheroidal tumours, possessing redness, heat, tension, violent throbbing pain, spontaneously suppurating. Not indeed essentially dif ferent from the character now offered, and involving most of its species. Vogel, however, makes it a part of its generic character that the inflammatory tumour, in order to be a phlegmon, must be at least as large as a hen's egg; while Dr. Turton, in his useful glossary, not knowing how to reconcile the clashing descriptions which are thus given of it, merely explains it after the Greek man

Hist. Anat. XIV. Cent. 6.

ner "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:

TUMOUR COMMON TO THE SURFACE; BRIGHT-RED; HARD; DEFINED; HEMISPHERICAL; POLARIZED; GRADUALLY 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 dif fers from it in having its pus uniform and mature, while that of the boil is always intermixed with a core. It is commonly a mark of high entonic health, or a phlogotic diathesis; and rarely requires any other medical treatment than bleeding, or a few cooling purgatives.

Where, however, pushes appear in crops, and especially 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 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.