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SURGEON'S
VADE-MECUM 
 
KH
 A?"            THE
A
           SURGEON'S
VADE-MECUM:
             CONTAINING THE
Symptoms, Causes, Diagnosis, Prognosis, and
               Treatment
                  OF
       SURGICAL DISEASES.
             ACCOMPANIED BY
  THE MODERN AND APPROVJED METHODS OF OPERATING,
     Select Formula; of Prescriptions,
           LATIN AND ENGLISH,
                AND A
        GLOSSARY OE^TERMS,
         ALBANY: ,
PUBLISHED AND SOLD BY E. F. BACKUS*
       No. 6?, State-itreet.

     E, and E. Hosford, printer*. 
   District of Neiv-Y'ork, ss.
    BE IT REMEMBERED, That on the twenty-ftfi'.i  day oi
     August, in the thirty-eighth year of the Independence of
the United States of America, E. F. Backus, of the  said
District, hath deposited in this office, the title of a book, the
right whereof he claims as proprietor, in the words following,
tp wit:
                          THE
      SURGEON'S  VADE-MECUM:
                      CONTAINING
The Symptoms, Causes, Diagnosis, Prognosis, and Treatmenc
  of Surgical Diseases ;  accompanied  by the Modern  and
  approved method of operating, Select Formulae of Prescrip-
  tions, Latin and English) and a Glossary of Terms.
  In conformity to the  Act of the Congress of  the United
States, entitled " An Act for the encouragement of learning, by
•' securing the  Copies of Maps,  Charts,  and Books, to the
" Authors and Proprietors  of such  Copies, during the time
" therein mentioned." And also to an Act, entitled " An  Act,
" supplementary to an Act, entitled  An Act for the encour-.
" agement  of  learning,  by securing  the Copies  of  Maps,
" Charts, and Books,  to the Authors and  Proprietors of such
" Copies, during the times  therein mentioned, and extending
" the benefits thereof to the arts of Designing, Engraving, and
■■' Etching Historical and other Pi-ints."
                          THERON RUDD, Clerk
                            Of the District of New-York, 
TO
HENRY CLINE,  ESQ.  F. R.  S.


  SENIOR SURGEON TO ST. THOMAS'S HOSPITAL:
    LECTURER ON ANATOMY AND SURGERY,
                &C &C


             THIS WORK


           IS RESFECTFULLY INSCRIBED,


        AS A TESTIMONY OF GREAT RESPECT

                   AND ESTEEM,


                BY HIS OBEDIENT SERVANT,


                        THE AUTHOR.
 
 
PREFACE.
    THE writer of this small volume, containing a
compendium of Surgery, has been induced to present
it to the publick, as a companion to the Anatomist's
and Physician's Vade-Mecum, and it is accordingly
conducted on the same plan.
  The arrangement of the diseases is such as is most
generally adopted in  works on Surgery.  The defini-
tion of every disease is  first  given.   The various
causes by which it is produced immediately,follow.
The diagnostick and prognostick symptoms precede
the cure, which contains the  modern and most ap-
proved methods of operating, and the best remedies.
  Throughout the  whole, the author has aimed at
brevity and perspicuity, and he trusts the student and
young practitioner, for whom it is principally intended,
will find he has not  been inattentive in selecting the
opinions of the most eminent surgeons in Europe.
  The work concludes  with a short explanation of
•cm is. 
 
             PREFACE
       TO THE AMERICAN EDITION,


    IT is unnecessary to say any thing in recommen*.
dation of this little Manual of Surgery : It obviously
forms an important sequel to the « Anatomist's" and
" Physician's Vade-Mecum" and will be found to con«
tain, in a very small compass, the most important facts
and observations in the science of Surgery.  In  this
work, as in the « Physician's Vade-Mecum,"  the
Formulae have been translated, and every attention paid
to ensure their correctness ; and we do not hesitate to
recommend it to the Faculty, as much for its intrinsick
value, as the neatness of its execution.
    Albany, August 24, 1813, 
,.    r.  ■*■ 
CONTENTS.
                                            fage
INFLAMMATION          -        _        1
    Phlegmonous Inflammation      -      -    ib,
    Erysipelatous Inflammation         -        4
  The Terminations or Consequences of Inflammation T
    Resolution        -         -        -      ib;
    Adhesion      -               -      -    ib.
    Effusion       -                           ib,
    Scirrhus        -          -        -       8
    Suppuration and Abscess         -         ib.
    Mortification        -        -      ••      10
WOUNDS        -         -        -         13
    The Incised Wound        -        -      ib.
    Wound of the Chest      -       -        18
    Superficial Wounds of the Abdomen    -    20
    Wounds of the Stomach      -      -      21
    -------of the Intestines          -        22
    -------of the Liver        -        -      24
    -------of the Gall-bladder        -        ib.
    -------of the Spleen, Kidney, and Reccp-
        taculum Chyli        -                25
    -------of the Urinary Bladder         -    ib.
    -------of Joints         -        -        26
    -------of the Neck        -        -      27
    -------of Tendons      -        -        28
    Contused and lacerated Wounds      -       29
    Punctured Wounds       -         -        ib. 
 Sli                COKTENTS.

    Poisoned Wounds       -       -          3'
    Gun-shot Wonnds         -        -       37
GENERAL BLEEDING        -        -     40
    I. In the Fort-arm        -        -        ib.
   II. In the Neck      -         -       -4*
   III. In the temporal Artery         -         42
  -W. In the Foot       -                     ib.
   Of the morbid Consequences of B'lood-letting    43
       I. Inflammation of the Integuments        ib.
      II. Inflammation of the Vein        -      ib.
    III. Inflammation of the Absorbents          44
    IV. Inflammation of the subjacent Fascia     ib.
     V. Wounded Nerve        -        -     ib.
    VI. Varicose Aneurism          -         45
 TOPICAL BLEEDING        -       -      ib.
    The Application of Leeches        -        ib.
    Scarification and Cupping      -      -     46
ISSUES          -         -         -        ib.
    The Blister-Issue         -         -     47
    The Pea-Issue          -         -        ib.
    The Seton         -        -              48
ULCERS          ...         ib.
    The benign or healthy Ulcer        -       49
      I. Local vitiated Ulcers     -      -     60
      II. Constitutional vitiated Ulcer      -       57
    Habitual Ulcer                            63
BURNS AND SCALDS        -              64
THE PARONYCHIA, OR WHITLOW        66
THE FURUNCULUS, OR BOIL       -       69
THE PERNIO, OR CHILBLAIN     -        70
THE ANTHRAX, OR  CARBUNCLE     -     ib
CONTUSIONS AND SPRAINS        -      7? 
CONTENT^.
%m
 TUMORS        .        .        ,         74
    Sarcomatous Tumors        -        -    ib.
    Steatomatous Tumors       «        -76
    Encysted Tumors        -        -       77
    The Ganglion        -        •      «    78
    Bronchocele        -                     79
    Cancer                                  82
    Enlargements of the absorbent Glands       ib.
    Aneurism        -         -        *      84
    The false or diffused Aneurism     -       88
    The varicose Aneurism        -      -    89
    Hernia                *        •         90
    Femoral Hernia          •        «       ib.
    Hernia Congenita       -       .  -         99
    Femoral or Crural Hernia        - ■        100
    Exomphalos        -        -      -     102
INJURIES TO THE BRAIN FROM EX-
      TERNAL VIOLENCE        -       103
    Concussion of the Brain         -          ib.
    Compression of the Brain      -     -    105
  Of the Consequences of Injuries to the Brain   108
    Fungus and Hernia Cerebri       -        ib.
    Inflammation of the Brain       -         110
THE DISEASES OF THE EYE      -      111
    Ophthalmia, or Inflammation of the Eye      ib.
    Gutta Serena, or Amaurosis       -       117
    The Cataract         -       -          118
    Wounds of the Eyelids or Eyeball     -     122
    Specks and Films        -        -        123
    Ptergyrium, or Excrescence      -         124
    Abscess        -        ■»       ►       123
    Ulcer                        *         126
                     A3   • 
*iv
CONTENTS.
                                            Tagt
    Fungus          -        -              126
    Hordeolum, or Stye        -       -       127
    Steatomatous Tumors and Warts       -     ib.
    Retortion of the Eyelids, or Gaping Eye     129
    Concretion of the Eyelids       -      -    ib.
    Dropsy of the Eye         -        -      130
    Protrusion of the Eye       -      -       ib.
    Cancer         -        -        -        131
    Fistula Lachrymalis         -    .    -      132
DISEASES OF THE EAR       -       -  .   135
    Inflammation and Suppuration      •>        ib.
    Accumulation of Wax        -        -    136
    Deficiency of Wax        -        -      137
    Closing of the Eustachian Tube       -      ib.
    Polypus         ...      138
    Atony of the  Muscles or Nerves of the Ear   ib.
    Deafness of old People      -       -      139
    Extraneous Bodies, in the Ear       -       ib.
    Imperforate Meatus Auditorius      -      ib.
DISEASES OF  THE  NOSE AND ITS
      APPENDAGES         -         -     140
    Haemorrhage from the Nose       -        ib.
    Polypi                                   141
    Ozcena         •         -        -      142
    Imperforate Nostril  ^                     ib.
    Collections of Matter in the Antrum of
      Highmore         -         -          143
    Cancer of the Antrum       -       -       ib,
    Collections of Matter in the Frontal and
      Sphaenoidal Sinuses       -       >•     144
DISEASES OF THE LIPS         -          ib.
    The Hare Lip        •        -           ib 
CONTENTS.
XV
    Cancer      ,            -        -      l4§
    Sarcomatous Tumor         -       -     147
DISEASES OF THE INTERIOR OF THE
      MOUTH       -         -       -       ib.
    Aphtha        -        -        -         ib.
    Mercurial Ulcers         -        -      148
    Tongue-tied         -        -           ib-
    Ranula         -        -       -        149
    Venereal Ulcers       -        -         150
    Scorbutic Ulcers         -         -       ib.
    Cancer of the Tongue        -      -      ib.
    Calculus of the Salivary Glands       -      151
    Division of the Parotid Duct        -       ib.
    Enlargement of the Tonsils        -       152
    Enlargement of the Uvula        -        153
DISEASES OF THE ALIMENTARY CANAL ib.
    Contraction of the Oesophagus        -      ib.
    Scirrhuo of the Pylorus      -       *      155
    Ulceration of the Intestines        -        ib.
    Scirrhous Contraction of the Rectum        156
    Imperforate Anus        -         -       ib.
DISEASES  OF THE  RESPIRATORY
       ORGANS         -        -          157
    Ulcer in the Larynx         -       -      ib.
    Suspended Animation       -       -  .    158
DISEASES OF THE CHEST         -      160
    Vomica, or Abscess of the Lungs     -     ib.
    Empyema       -        -       -      ib.
    Collections of Blood in the Chest      -    161
    Collections of Air        -         -      162
    Hydrothorax        -        -       -    ib.
    Paracentesis of the Thorax        -       ib,
    _--------_,     Abdomen         -      163 
SYl
CONTENTS.
DISEASES OF THE BREAST
    Inflammation        -        »
DISEASES OF JOINTS
    Hydarthrus              -       *
    Ganglion        ...
    Collections of Blood
    Collections of Matter
    White Swelling
    Cartilaginous and Fungous Substances
      within the Capsular Ligaments
    Disease of the Hip-joint
    Psoas Abscess
DISLOCATION        »
    Of the Lower Jaw
          Head                      >
          Spine
          Clavicle
          Humerus             v      ,
          Radius and Ulna           -
          Wrist
          Hip
          Patella       -         r
          Tibia       -       *
          Ancle
DISEASES OF BONES
    Inflammation         -         »•
    Abscess        i-         -        -
    Mortification        -
    Caries of the Spine        *
    Exostosis
    Rachitis                 -
    Mollities Ossium        * 
CONTENTS,,
   Fracture        .        .        -
      Of the Bones of the Nose
            Lower Jaw
            Clavicle        -        •
            Ribs
            Scapula
            Humerus         *
            Radius and Ulna        *
            Os Femoris
            Patella        -.
            Olecranon        -'
            Tibia and Fibula
            Fibula alone       -      ■»
    Compound Fracture
DISEASES OF  THE URINARY AND
      GENITAL ORGANS
    Calculus
    Stone in the Urethra
    Incontinence of Urine, or Euneuresis
    Strangury, or Retention of Urine; or
      Dysuria and Ischuria
    Rupture of the Urethra
    Fistula in Perineo
    Enlargement of the Prostate Gland
    Gonorrhoea       ...
      Stricture
      Phymosis      -
      Paraphymosis
    Cancer of the Penis
    Hydrocele        -
    Varicocele, or Circocele         -
    Hernia Humoralis         *- 
tfVili               CONTENTS.
                                             Page
    Scirrhus of the Testicle         -           237
    Haematocele         -          -           239
DISEASES ABOUT THE ANUS      •      240
    Haemorrhoids, or the Piles        -          ib.
    Fistula in Ano        -        -          243
    Prolapsus Ani         -         -         245
    Condylomatous Excrescences       -       247
    Imperforate Anus        -       -         ib.
SYPHILIS         -       -        -         248
  it- Of primary or local Symfitoms        -       ib.
    Chancre         -        -        -        ib-
    Bubo        -                           249
  «. Of secondary or  constitutional Symfitoms.     251
    Sore Throat                                ib.
  General Treatment  of Syfihilis         -       252
    Eruption        -        -        -       253
    Ulcers                                   254
  ' Ozcena          -                        255
    Ophthalmia           -          -        256
    Pains        -                    -        ib.
    Node       -       -       -       -     257
AMPUTATION       -                      358
    Of the Fingers         -         -          ib.
    At the Wrist         -        -           259
    Of the Tarsus          -         -          ib.
          Thigh          -         -         260
          Leg       -                         261
          Humerus        -         *         262
          Fore-Arm        -        -         ib.
    At the Shoulder Joint       «       -       ib. 
 
 
THE
SURGEON^  VADE  MECUM
OF INFLAMMATION.

      character.
JL AIN;—increased redness and heat;—swelling;-
tension.
c  .     Ci- Phlegmonous.
Species,  j        °               .
         £ n. Erythematous, or Erysipelatous.
   OF PHLEGMONOUS INFLAMMATION.
                   symptoms.
  Phlegmonous inflammation  usually comes on  with
itching and dryness in the affected part; which symp-
toms are  shortly succeeded by increased heat and cir-
culation ;—.circumscribed tumefaction;—shooting and
throbbing  pains.
  If the inflammation run high, and be of considerable
extent, an increased action of the heart and arteries
takes place ; the pulse becomes full,  hard, and quick ;
the skin dry and hot; great thirst arises, and a fever-
ish disposition ensues; the tongue is white; the  urine
high coloured ;  and the blood,  when drawn from a vein,
exhibits a glutinous separation upon its surface.
                     CAUSES.
  Stimuli, either mechanical,  chemical, or nervous; as
external injuries by  bruises, wounds, compression. Sec
                        B 
2
PHLEGMONOUS INFLAMMATION.
 '—irritation  produced by the presence  of extraneous
 bodies,  of whatever kind ;—the application of cold ;—
 any cause that determines an increased or irregular im-
 petus of blood to the part; as violent exercise, certain
 diseases, an inordinate influx of nervous energy.
                     PROGNOSIS.
   The prognosis in inflammation will be drawn from
 the violence of the  symptoms ;  and from the seat of
 the inflammation.
   Favourable.—-The pain, heat, redness, and other in-
 flammatory symptoms, gradually diminishing, and at
 length altogether ceasing (see the Terminations of In-
 flammation)^— or the swelling becoming more circum-
 scribed ;  prominent in the centre ; soft and fluctuating
 (see Suppuration); the constitution  at the same time
 being little affected.
   Unfavourable.—Violentfever with delirium ;—the in-
 flammatory appearances suddenly ceasing ; followed by
 the formation of blisters,  discharging a thin ichorous
 matter:  the part becoming of a livid  colour, and lo-
 sing its sensibility.   See Mortification, fo ■
                   TREATMENT.
                 i.  To  remove  causes  that  are ob-
                     vious and continue to operate.
                 n.  To  reduce the  morbid action of
 Indications.  <^      the vessels of the part.
                 i. To mitigate  the concomitant fe-
                    ver, should the system have be-
                    come affected.
                        i.
  The first indication will be  fulfilled by attending to
the manner in which the  inflammation was excited.__
To effect the removal of some causes, an incision will,
under certain circumstances,  become necessary; as 
            PHLEGMONOUS INFLAMMATION.           3

when the  inflammation has  proceeded  from  the pre-
sence of any extraneous body.
                           n.
   The  second indication will  be answered:
   1.  By local bleeding.
   The  application of leeches, cupping, and scarifica-
tion of the part.
   2.  By sedative and refrigerant lotions, kept constant-
ly on the part; as,
   Aqua lithargyri acetati com-  Compound Solution  of Acetite
posita.                         "f lead.

R. Aquae  ammoniae  acetatae,  Take, ivaler  of Acetite of Am-
                                       monia.
   Spirltus camphors, aa p. ae.    Spirits  of Camphor  each
                                 equal parts.
R. Ammoniac muriatae 5j.      Take Muriate of Ammonia  ±i.
   Aceti communis  Ziv.         Common vinegar   ?iv.
   Aquae distillatae 5xj.  M.      Distilled water  ~xi. Mix.

    LOTIO SPIRITUOSA.         SPIRITUOUS LOTION.
        Phtirm. Chir.
R. Spiritus  vinosi rectifica-       Take Alcohol %\v.
  ti   5iv.
   Aquae calcis ?viij. Misce.   Lime-water  5viij.   Mix.
   3.  By aether cautiously applied so as to produce cold
by evaporation.
   4.  By cold and sedative cataplasms.
R. Aquae lithargyri  acetati  Take  compound -water of Ace.
    composilae J^j.                   tite of leadjfoi.
   Spiritus vini rectificati  ?ij.    Alcohol   ?ij-
   Micae panis q. s.               Crumb of bread  g. s.—make
                                 a cataplasm.
    CATAPLASMA I.INA.         FLAXSEED POULTICE.
        Pharm. Chir.
   This is  made by stiring  a  sufficient quantity of the
meal into boiling water. 
-4
ERYSIPELATOUS INFLAMMATION.
CREMOR LITHARGYRI ACE-   CREAM OF ACETITE OF
         TATI.                     LEAD.
       Pharm. Chir.
R. Cremoris lactis 5j.         Take Cream ^i.
  Aquae  lithargyri  acetati    Water of Acetite of Lead
     5J. M.                          5i-  Mix.
  To be applied as a liniment, or spread upon linen.
                       in.
  The third indication requires :—
  1. General bleeding.
  2. Purging-with the saline purges, as magnesia vit-
riolata,  natron vitriolatum, kali  tartarisatum, kali vit-
riolatum, natron tartarisatum.
  3. Diaphoretics,  more  especially pulvis antimonia-
lis with opium,  and the saline  sudorifics that are re*
commended by medical authors against inflammatory
fever.
  If the pain be very severe, opium, must be  admin-.
istered after evacuations have been premised.


   OF ERYSIPELATOUS INFLAMMATION,
                    SYMPTOMS.
  Roughness, heat, and pain, succeeded by an irreg-
ular, but  circumscribed redness of the skin; at first
vivid,  afterwards assuming a more dull or dusky hue
upon pressure,  and again returning to its  former co-
lour, when the cause of compression is removed ; ex-
tending over a large  surface,  and  as  it extends often
leaving,or abating in the  parts it first occupied.—The
part affected swells, but the swelling differs from that(
 in the former species, in  being general, diffused, and
 uniformly smooth ; not consisting in a sudden and mark-
 ed elevation of the integuments.—The heat is peculiar-
 ly acrid and mordent.—If the  inflammation be exten- 
          ERYSIPELATOUS  INFLAMMATION.         5

sive, the patient becomes affected with fever ; the pulse
is  usually small, hard  and frequent;  the  tongue at
first white, afterwards becoming brown.—After a short-
er or  longer continuance  of the  inflammatory symp-
toms, the redness diminishes, the part becomes  yel-
low, the cuticle falls off in scales ; or vesicles are form-
ed containing a limpid, in some cases a yellowish, fluid.

                     CAUSES.
   Erysipelatous inflammation may arise from the same
causes as the phlegmonous ;—it is more liable to at-
tack women and children, and  those  of an  irritable
habit, than the plethoric and robust-—Some people are
so peculiarly predisposed, that no accident,  however
slight, fails to induce it; and every inflammatory affec-
tion puts on the erysipelatous form.

                     PROGNOSIS.
   Favourable.—The inflammation of a vivid red colour,
and not  extending  over a large surface;—the fever,
when the constitution has become affected, assuming
the inflammatory form ; the pulse being full, and not
rapid ; the tonge white ; the strength little impaired.
   Unfavourable.—-The  inflamed  parts  becoming  of a
dark red or rose colour, brown,  or livid ;—the inflam-
mation rapidly extending ;—the fever assuming the ty-
phoid  form, the pulse small, hard, and rapid;  the
tongue covered with a brown fur ;—coma ;—delirium ;
__great  prostration  of  strength ;—sudden depression
of the swelling, succeeded by livid vesications.
B  2 
6
ERYSIPELATOUS  INFLAMMATION.
Indications.-:,
       TREATMENT.
"i. To reduce the inordinate action of the
   vessels, and to diminish the  heat and
   other local inflammatory symptoms.
 n. To moderate the feverish affection of
   the constitution by means appropriated
   to the particular form it may assume ;
   and  to  obviate  the tendency to  gan-
   grene, if there be great prostration of
   strength, by increasing the tone of the
   system in general.
  The following  are the local  applications  most fre-
quently employed to fulfil the first indication.
  Spiritus camphoratus alone, or united with the aqua
lithargyri acetati:
R. Aquae lithargyri acetati 5J-
Take Water of Acetite of Lead,

  Alcohol,  j?iv.
  Distilled water
Make a lotion.
JV1J-
  Spiritus vini rectificati ziv.
  Aquae distillatae 5vj.
Fiat lotio.
   A dilute solution of zincum vitriolatum
R. Zinci vitriolati Jij.
  Aquae distillatae 5xy-
Solve.
   Lime-water, with the addition of spirit:
R. Aquae calcis 5xij.          Take Lime-water
   Spiritus Vini rectificati zij.     Alcohol £ij
Fiat lotio.                   Make a Lotion.
   The steam of warm  water  impregnated with cam-
phor.
   Emollient fomentations and cataplasms are by some
much used ; by others they are thought prejudical.
   Unctuous applications are seldom of service; yet
Take Sulphate of Zinc Jij.
  Distilled water 5xij.
Dissolve.
;x,j- 
        TERMINATIONS OF  INFLAMMATION.       7

the ceratum lithargyri acetati, and the unguentum ce-
rusae  acetatae, of the London Pharmacopoeia, may be
used with advantage.
  When an effusion of lymph has taken place, absorb-
ent powders are commonly employed as topical appli-
cations ; such as starch,  wheat flour, oatmeal,  chalk,
or litharge : of these the oatmeal is perhaps preferable.
                        n.
   The means for fulfilling the second indication are de-
tailed by authors on medical diseases.  See Inflamma-
tory Fever,  Typhus Fever,  and Erysipelatous  Fever,
or Erysipelas. ®L*t*<*<-***■'* 2^»*U-sf€&c**r~y, Z4-/6, /*f ■

 Of the Terminations or Consequences of Inflammation.
   The terminations  of inflammation are—resolution,—
adhesion,--effusion,-—scirrhus,——suppuration,—gan-
grene.
                OF RESOLUTION.
   By resolution is meant a gradual subsidence, or go-
 ing off, of all the inflammatory  symptoms; the state
 and texture of the part remaining entire.
                 OF  ADHESION.
    Adhesion is when coagulable lymph has been thrown
 out from the orifices of  the inflamed  vessels ;  and by
 its agglutinating qualities  has cemented as it were
 membranes,  or other contiguous parts, together.
    When adhesion is completed, vessels shoot from the
 opposite surfaces, through the coagulable lymph, and
 anastomose,  so as to completely organize the lymph,
 and form it into cellular membrane.
                  OF EFFUSION.
    This termination is peculiar to cavities lined with
 smooth diaphanous membranes.—The fluid effused is
 various, and depends  upon the nature -of the  inflam- 
8        TERMINATIONS OF  INFLAMMATION.

mation, the  strength of the inflamed vessels, and the
structure of the part.—It may possess all the interme-
diate degrees or properties between  serum, coagula-
ble lymph, and pus.
                OF SCIRRHUS.
  Scirrhus or induration  is when the  inflammation
leaves the part hard and swollen.  It is a termination
of inflammation more peculiar to glandular parts.
     OF SUPPURATION AND  ABSCESS.
                    SYMPTOMS.
  Suppuration is the process of the formation of pus.
—Its accession is  marked by rigors, if  the inflamma-
tion be considerable ;—dull heavy weight of the affect-
ed part;—by the pain becoming more lancinating, and
accompanied, with a peculiar throbbing  of the neigh-
bouring arteries ;—fluctuation ;—by  the swelling be-
coming gradually more elevated above the surface of
the surrounding cuticle ;  acquiring a softness to the
feel, and showing a tendency to point in one particular
place.—If the process be suffered to go on without in-
terruption, the integuments become more and more
thin, and change to a  whitish or yellowish colour;—-
they at  length lose their firmness, give way,  and pus
is discharged at the opening.
                   TREATMENT.
Indications.  $I# To exPedite the process of suppuration.
            C n. To evacuate the contained matter.
                        i.
  By fomentations and emollient cataplasms.
  Fomentations of chamomile-flowers.
  Cataplasms  of linseed-meal,  or the common white
    bread poultice, with a small addition of oil.
  Should there be  great pain and irritation, opium in-
ternally > the external application of sedatives. 
TERMINATIONS OF INFLAMMATION.        9
  The decoctum pro fomento  Ph. Lond.  or the poppy
fomentation:
  FOMENTUM PAPAVERIS     FOMENTATION OF WHITE
          ALBI.                     POPPY.
        Ph. Ghir.
R. Papaveris albi  exsiccati  Take White Poppy dried ?iv.
      5iv.
   Aquae purae  ffovj.             Pure water  J^iv.
  The poppies are to be bruised, and then boiled till
there only remains a quart after straining.
  The hemlock fomentation of Guy's hospital:
   FOMENTUM CICUTJE.      HEMLOCK FOMENTATION,
        Ph. Cuy.
R. Cicutae  5iv.             Take Hemlock cut fine   5iv.
   Chamaemeli excisi  ±ij. "        Chamomile do   ?ij.
   Aquae ferventis ftyv.  Ma*      Boilingwater ffjiv. Mace*
      cera.                       rate.
  If the process  of  suppuration be  extremely slow,
and there are  marks of local, or constitutional debility,
the topical use of stimuli.
  The common cataplasm, with the addition of a small
portion of strained galbanum.
  OLEUM  PALH£ CAMPHO-      CAMPHORATED  PALM
         RATUM.                      OIL.
         Ph. Chir.
R. Camphorae  §ij.          Take Camphor  ?ij.
   Olei palmae   jfoj.              Palm Oil  f^\.
  Fomentations, as warm as the patient can bear, often
repeated.
  The emplastrum cumini of  the London  Pharmaco-
poeia.
  The emplastrum ladani compositum Ph. Lond.
  Dry cupping; Mr, Hunter.
  Electricity.
  The internal  administration  of  Peruvian bark, with
a moderate use of wine, and a nutritive diet. 
10       TERMINATIONS OF INFLAMMATION.
                         II.
  The means of effecting the second indication, now
almost solely employed by modern surgeons, is  an in-
cision made with a common  or abscess lancet.  If the
tumor be small the opening  may be free, and the con-
tained matter may at once be evacuated; but if it be
of large size,  and the constitutional irritation be consi-
derable, the opening should be small, and the matter
evacuated  very gradually, or at  several  successive
times.  The proper period for performing the opera-
tion is, as  soon as a fluctuation  can be  distinctly per-
ceived, and the tumor shows a tendency tn point ta  a
particular  place.—The place most advantageous for
the incision, is the depending-part of the swelling,
              OF MORTIFICATION.
                     SYMPTOMS,
  Excessive, acute, and constant pain ; great anxiety ;
often delirium, followed by a sudden cessation of eve-
ry inflammatory symptom.—.The part before tense now
becomes flaccid, of a  livid colour, and loses its heat
and sensibility.—Vesications are formed, under which
are perceived spots of a brownish hue.—The parts ac-
quire a fetid smell, and  become black.—If the  event
prove favourable, the mortified portion becomes com-
pletely circumscribed; a process of ulceration  is set
up in the  contiguous  living  substance, by which the
dead  matter is  separated, and  at length cast  off in
sloughs   If, on the contrary,  the termination be fatal,
the mortification rapidly  extends, great constitutional
irritation arises, the pulse becomes small,  rapid, and
irregular, there is a fixed flush upon the  countenance,
with  great anxiety and  prostration of strength, and
death soon ensues. 
         TERMlNA 1 IONTOT WT-LAMMATION.       ll

                      CAUSES.
  Predisposing.—Whatever weakens the powers of the
system in general, and of the part in particular; as the
debility induced by disease,—great losses of blood,—
old age, Sec.
  Exciting.—Inflammation induced by whatever cause ;
—external injury, as contusion, pressure, See.;—what-
ever diminishes the vital energy, lodged in the part, to
a degree, incompatible  with the  performance of its
functions; as the sedative operation of cold,  certain
fevers,
                     PROGNOSIS.
  Mortification is always to be esteemed the worst ter-
mination of inflammation.—The circumstances which
lead to a prognosis  of a favourable event, are—youth
and strength of constitution,—the general system little
affected  by the local  disease,—the pulse  continuing
full,—there being little irritation ;—a  disposition to a
separation of the sound from the diseased parts ; mark-
ed by a white line, somewhat elevated, distinctly bound-
ing the latter,  about which an oozing of a serous fluid
is observed.
                    TREATMENT.
             r To prevent the extension of the mortifi-
Indications.<   cation, and to promote a separation of
             L   the dead parts from the living.
   I. By a liberal use of the Peruvian bark,  with nutri-
tive diet, and a  sufficient  quantity of wine  to keep up
the tone of the system,  and of the part, and to excite
the necessary degree of slight inflammation.
   2. By opium ; especially in mortifications from de-
bility,  and in gangrene of  the toes and feet  of old peo-
ple.  Pott.
   3. In cases of  gangrene from local injury, the com-
bination of musk with ammonia. 
12       TERMINATIONS OF  INFLAMMATION.
R. Moschi,
 Ammoniac preparatae.aa ^ss.
Take Musk.
  Carbonate  of Ammonia each
        9ss.
  Mucilage of Gum Arabic q. s.
Make four pills,  to be taken ev-
  ery three hours.
  Mucilaginis Arabici q  s.
Fiat pilulae quatuor, tertia qua
  que  hora  sumendae.—Mr.
  White of Manchester.
  4. The local application of tonics and stimulants.
  Fomentations  of oak bark.
  Lotions of very dilute nitric acid, or ammonia muri
ata, or nitre.
R. Acidi nitrici Jij.           Take Nitric AcidZ'y
  Aquae distillatae  2xvj.  M.     Distilled water ?xvi.  Mix.
R. Ammoniae muriatse jrj.
  Aceti communis 5v.
  Aqux distillate tx.  M.
Take Muriate of Ammonia  j
  Common Vinegar ?v.
 Distilled-water ^x.   Mix.
R. Nitri purificati zj.
  Aceti communis ?v.
  Aquae distillatae ?x.  M.      Distilled Water ?x~ Mix.
  The camphorated spirit.—Spirit of turpentine.
  Fermenting poultices :—•
Take Nitrate of Potash
  Common Vinegar  jlx.
  Distilled Water "
CATAPLASMA  EFFERVES-
         CENS.
EFFERVESCING POULTICE.
       Pharm.  Chir.
  This poultice is prepared by stirring into an infusion
of malt (such  as may be  readily obtained from the ale
or porter brewer)  as much  oatmeal as is required to
make it of a proper thickness, and  afterwards adding
about a spoonful of yeast.
CATAPLASMA CARBONIS.
      Pharm Chir.
CHARCOAL POULTICE.
  To about  half a  pound of the common farinaceous
cataplasm, two ounces of wood  charcoal,  in very  fine
powder, are to be  added, and the whole  mixed well
together. 
THE INCISED WOUND.
P
  C/.u-honic acid gas in every form
  The gastric juice  of  graminivorous animals.—Dr.
Ilar/'t'f-s,  Transactions of the  Society for the Improve-
ment of medical and surgical Knowledge.
  Slight scarifications of the diseased parts are recom-
mended by some.
  Tne most proper form of ointment is the ungentum
re sin a: fiavae,  with the addition of spirit of turpentine,
or the warm dressing of the hospitals.
                  OF WOUNDS.
  By a wound is  meant a recent solution of the con-
tinuity of the animal solid, from external violence.
                  i. Incised.
                 n. Lacerated.
                m. Contused.
                iv. Punctured.
                 v. Poisoned.  .
                vi. Gun-shot.   .
Sjiecies. <
■r.
          OF THE INCISED WOUND.
  A wound inflicted by a cutting  instrument; and in
which there is  a simple  division of the part, without
anv, or any considerable, loss of substance,—The usual
and immediate consequences are,—a  greater or less
retraction of the divided parts, according to the tex-
ture of the particular portion of the body which is the
seat of tut accident ; and a discharge of blood propor-
tioned in quantity to the size of the injured vessels.
        PROGRESS  OF SPONTANEOUS UNION.
  By the first intention.—When the edges have sepa-
                       C 
14
THE INCISED WOUND.
rated only to a certain distance, or still remain in oppo-
sition, a portion of blood is thrown out from the inci-
sed orifices of the arteries, by which the chasm is fil-
led.—The lips of the wound become tumid and pain-
ful, a slight inflammation ensues, under which vessels
shoot into the inorganized coagulum.—This soon be-
comes endued with life, and thus a complete union is
effected.
  By granulations.—When, however, from the nature
of the part, or from other causes,  the edges have re-
tracted to a considerable extent, this species of union
is prevented from taking place,  suppuration  super-
venes, pus is formed ;  granulations arise, and, increas-
ing,  fill up the  cavity; and,  having attained the sur-
face, cicatrization commences, processes of skin shoot
from the surrounding edges,  and extending, at length
completely enclose the newly-formed parts.
                    PROGNOSIS.
  The prognosis will  chiefly depend upon the situa-
tion  (see wounds of the different parts of the body),
and the extent of the wound.
   Unfavourable circumstances are—great irritability of
constitution ; the constitution of the patient impaired
by age, or  inebriety;—debility, however induced;—
the division of large arteries,  or of numerous absorb-
ent vessels ;—-the firm texture of the part favouring a
considerable retraction of the edges;—the presence
of certain extraneous  bodies,  which cannot be readily
removed;—too  great inflammation, when sphacelus is
likely to ensue;—deficient inflammation,  when the
progress of union is retarded, or entirely suspended: 
THE INCISED WOUND.
15
                   TREATMENT.
            "  i. To put a stop to the haemorrhage.
              n. To remove  any extraneous  bodies
                  that may happen to be present.
Indications.<         „,            .  Al  c  . • *„_
            | m. To effect an union by the first inten-
                  tion, or, if that be impracticable, to
            L     promote the formation of pus.
                        i.
  An haemorrhage may be stopped by simple pressure
with the  finger, compress, or bandage,  if the  wound
be slight, or  the haemorrhage  trifling ; but when a con-
siderable artery has  been divided, and the effusion of
blood is copious, by the  application of the tourniquet,
in situations where its use is admissible, and by after-
wards securing the divided vessel with a ligature.
   In  the application of  the  tourniquet, a small linen
compress or cushion is to be  placed over the course of
the bleeding vessel, in the most eligible situation above
the wound (see Amputation, where the proper posi-
tions for its  application are pointed out), and secured
by means of a roller passed two or three times around
the limb.—The instrument  is now to be applied with
its handle in a position opposite to the compress upon
the vessel, and rendered firm by the strap to which k is
affixed ;  after which, by turning the handle, and there-
by tightening the  compress,  the haemorrhage will be
restrained.
   The next object is to secure the bleeding vessel; for
which purpose two modes are practised:  1. by means
of the tenaculum ; 2. by means of the crooked needle.
The former is now generally preferred.
   The tenaculum is a curved hook, the point of which
is to be passed through the coats of the divided vessel,
which being pulled out beyond the surface of the wound, 
16
THE INCISED WOUND.
a ligature, composed of threads proportioned in num->
ber to the size  of the artery,  previously waxed,  and
loosely slipped over the instrument in the manner of a
ring,  is to be drawn by an assistant over its point, until
it  encircle the extremity of the vessel; when its ends
are to be gradually, yet firmly drawn, so that.the sides
of the latter may be effectually compressed.   It is then
to be  secured by a second knot,  and the ends being cut
off at a proper distance, are to be suffered to hang from
the wound.
   When, however, from  the depth of  the wound, ov
from  the artery having retracted beyond the reach of
the tenaculum, there is a necessity for using the crook-
ed needle ; this armed with a proportionate ligature is
to be introduced at about a quarter of an inch from the
situation of the vessel, to  be  carried  under  it,  and
brought out at the same distance on the  opposite side ;
and this being  repeated, a knot is to be made as above
directed.
  A constant oozing sometimes takes place  from the
surface of a wound, either owing to a relaxed state of
the part, as indicated by a  general relaxation and debil-
ity of  habit, or from too plethoric a  state of constitu.
tion.—In  the  former case  astringents  and balsamics
have been  successfully employed ; such as tercbinthi-
na,—alkohol,—myrrh,—tinctura benzoes compesita,—
powdered myrrh,—galbanum,—gum Arabic.—In the
latter—bleeding,—purging, &c.
                        n.
  The second indication  is effected either by the for-
ceps or probe, according to the size or situation of the
extraneous bodies ; or more effectually by careful ab-
lution with a sponge and warm water, or by the use of
the syringe. 
THE INCISED WOUND.             17
                       III.
  Union by the first intention is to be effected by draw-
ing the divided parts closely into contact;  and retain-
ing them in that situation by means  adapted to the ex-
tent and situation of the wound.
  If the wound be small,  or however extensive it may
be, provided it  be superficial only,—adhesive straps
are the  most  proper application  for this  purpose.—
Their number should be in proportion to the extent of
the wound; their  breadth about an inch and an half;
and in applying them, one end is to be fastened at a
moderate distance from the edge on one side, and while
the union of the parts is preserved by an assistant, the
other is to be conducted over to the opposite, and being
drawn tight, is to be affixed to the integuments by pres-
sure with the warm hand.—>A small aperture should
be left between the straps, in the most depending part
of the wound, for the evacuation of any matter which
may happen to form.
  Where the wound is of considerable depth, or where
the edges have much retracted, as also more especial-
ly in wounds into cavities,—into the joints,—in wounds
of the face and neck, in all triangular wounds,—and in
transverse wounds  of muscles,—the use of the inter-
rupted  suture becomes  necessary.—In making this,
the fewer the number of stitches in general, the more
speedy and effectual the union.—Each needle, with an
appropriate ligature attached to it,  is to be introduced
at a distance from  the edge,  equal to half the depth
of the wound ; and being carried to near the bottom,
should be drawn out at a  corresponding point on the
opposite side___The threads of each needle are to be
cut successively of an equal  and  moderate length;
but not  secured  until the whole have been passed.—
Adhesive straps  should now  be  applied between the
                       C2 
IS            WOUNDS OF THE CHEST.
stitches, in the manner above described ; and the whole
covered with a compress of lint, and a loose roller.
  Should pain, tension, and inflammation, succeed the
application of ligatures, recourse must be had to emol-
lient poultices and fomentations,—topical bleeding, or
refrigerant applications,  as the compound  water of
acetated litharge ;—and if these be ineffectual, the lig-
atures should be removed.
  Few  wounds, in the improved practice  of  surgery,
require to be united by suture ; the adhesive straps arc
generally found equally effectual, and have the advan-
tage of not creating irritation.
  When union  by the first intention is impracticable,
suppuration  must be  promoted  by appropriate means.
—See Contused Wounds,' and Abscess.


        OF  WOUNDS  OF  THE CHEST.
  Some authors divide wounds of the chest into four
species :—a division into two  will,  however,  be  quite
^sufficient.
          r  i.  Where the wound penetrates the cavity
 Sfecies.  <    without injuring the viscera.
          Lii. Where the viscera are wounded.
               DIAGNOSTIC SYMPTOMS.
   Of the first species.—Extreme anxiety and  difficulty
 of breathing; at each inspiration the lung protrudes
through  the wounded part; great  irritation  at the
larynx;—cough ;—and the patient,  upon  attempting
 to lie down,  feels a sense of suffocation.
   Of the second species.—Blood is coughed up of a
 florid red colour, frothy and mixed with air;—great
 difficulty of breathing ;—in inspiration, air  is I card to
 issue from  the external wound with a hissing noise,
 and to  rush in with a  similar sound during  expiration; 
WOUNDS OF THE CHEST.
ly
—emphysema very generally takes  place, first begin-
ning in the ceilular membrane of the thorax,  and often
spreading to a great extent.
                    PROGNOSIS.
  In all wounds of the chest the prognosis will be unfa-
vourable.—iTne first species, however,  is not to be es-
teemed a very dangerous  wound, as numerous instan-
ces have occurred in which recovery was speedy and
perfect.  T'.ie great sources of danger  are, inflamma-
tion attacking  contiguous vital  parts,  and matter  or
blood collecting in the cavity of the  thorax.
  In the second species it will be extremely unfavour-
able ; and  generally fatai.—Circumstances especially
indicating  danger arc—supervening inflammation ;—
abscess and hectic  fever; marked by rigors,  colliqua-
tive sweats,  diarrhoea, &c.—Wounds  inflicted in the
pericardium, the large vessels, or the heart itself, will
always be fatal.—Excessive haemorrhage ;—the patient
being the subject  of visceral disease, more especially
of the organ wounded.—The habit otherwise depraved.
                    TREATMENT.
  Of the first species.—Should  the haemorrhage  be
considerable, it is most likely to proceed from a divi-
ded intercostal artery ; to secure wi ich Mr. Latta re-
commends a free dilatation  of the wound,  and the ap«
plication of a ligature.—Long-continued pressure with
the finger upon the bleeding orifice has  often  been suf-
ficient.
  The wound is afterwards to be united by suture ; in
making which care is to be taken that the ligatures pass
through the integuments and muscular substance only,
without penetrating the pleura.
  Should inflammation supervene,  or blood  be accu-
mulated in the  cavity of the chest,  the  treatment will
be that applicable to the second species, 
20    SUPER FICIAL WOUNDS OF THE ABDOMEN.

   Of the second species.—After the suppression of the
haemorrhage, the chief object is  to prevent inflamma-
tion supervening,—by copious and  repeated bleedings,
—purging,—a strict antiphlogistic regimen, and other
means recommended for the treatment of inflamma-
tion.—-See Inflammation.
   The union of the wounds should not at first be at-
tempted ;  but  being  simply covered with a compress
of lint, the  patient should be laid in such a position
that it may be in the most dependent part of the tho-
rax.—Any blood which would  otherwise be collected
in the cavity of the chest will thus  be evacuated at the
external wound.—After the expiration of twelve hours
it may be closed as above directed.
   Should  an accumulation of blood  or matter take
place in a few days after the healing of the external
wound, which is not an unfrequent circumstance,  and
is marked by—extreme difficulty of breathing,—sense
of weight and immense oppression at the chest,—pur-
ple flush of the countenance,—difficulty  of lying upon
the opposite side,—the operation for empyema should
be performed, and the collected fluid evacuated.—See
Empyema.
   If  emphysema be present, small punctures should
be made at different places in the tumefied part.


   OF  SUPERFICIAL  WOUNDS  OF  THE
                  ABDOMEN,
   Wounds in which the integuments of the abdomen
have  been divided without injury to the contained vis-
cera
   They are dangerous, or  not, in  proportion  to their
extent;—small  ones  are seldom fatal,  unless certain 
WOUNDS OF THE STOMACH.
21
adverse circumstances of  constitution be  present—
Sec Incised Wounds.   '
                   TREATMENT.
  After suppression of the haemorrage by the usual
means, union is to be effected by the suture ; and in
wounds into large cavities the  quilted suture is to be
preferred to all others.
  The quilted suture is simply  the interrupted suture
with a double ligature, and supported by small cylindrical
bodies (pieces of quilt or bougie) placed on each side of
the wound, by which its edges are more effectually com-
pressed.—The double of the ligature is made to enclose
the one, and the knot is to press directly upon the other,
and by  tins means the sides of the wound are made
closely to aproximate.
       OF WOUNDS OF THE STOMACH.
               DIAGNOSTIC SYMPTOMS.
  Almost  instant  fainting ;—the pulse becomes  ex-
tremely  small, and so rapid as with difficulty to be
counted ;—a cold sweat breaks out over the surface of
the body ;—vomiting  comes  on,  by which blood is
brought up;—hiccup;—delirium.—Alimentary matter,
mixed with blood, escapes at the external wound.
                    PROGNOSIS.
  The prognosis will ever be unfavorable.—The wound
generally proves fatal, cither from the sympathetic effect
of an injury done to so important an organ ; or from the
escape of blood or food into the cavity of the peritoneum.
                   TREATMENT.
  The wound, like all others into large cavities, should
not be closed until all haemorrhage has ceased, until
which time the patient should be laid  in a  situation, in 
22*        WOUNDS OF THE INTESTINES.            f*

which any blood, already collected, may be evacuated.—
It is afterwards to be united by the interrupted suture, as
above described.—Inflammation  should be obviated by
a strict antiphlogistic regimen,—-repeated bleedings-
warm fomentations,—and emollient enemas.—The pa-
tient should entirely abstain from food, and all nutrition
should be conveyed by clysters of broth, milk, and other
nutritive ingredients ;—the thirst should  be  allayed by
a small portion of jelly, or other  substance, held in the
mouth.
  Provided the event be favourable, in eight days  food
may be taken by the mouth.
     OF WOUNDS OF THE INTESTINES.
              DIAGNOSTIC SYMPTOMS.
  Sudden and great prostration of strength ;—loss of
pulse ;—bilious  or feculent matter issuing from the
wound;—bloody stools ;—most violent colic pains ;—
nausea ;—vomiting ;—cold sweats.
                    PROGNOSIS.
  These, like wounds of the stomach, generally, though
not universally, terminate fatally.—The event will, in
great measure, depend upon the possibility of uniting
the opening in the intestine.
                   TREATMENT.
  When the intestine  has  receded into the abdomen
beyond the reach of the surgeon, the same observations
will apply to this as to a wound of the stomach.
  But when the divided portion protrudes through the
external  wound, as is  not  unfrequently the  case, at-
tempts should be made to procure an union of the parts
by suture.
  If the woundbe longitudinal, the uninterrupted suture 
           WOUNDS OF THE INTESTINES.         ~$3

will be preferable.—The mode of making this consists
in inserting stiches, with a common needle, at a mode-
rate distance from each other, in an oblique spiral direc-
tion, along the course of the wound, without however
dividing the thread, as in other species.  The intestine
is then to be returned into the abdomen, and being con-
fined close  to the external  wound  by the  ligatures,
suffered to hang out, an adhesion generally takes place
to the peritoneum; and when an union has been effected,
the threads may be withdrawn.
   To unite circular or transverse wounds of the intes-
tines, various plans have been recommended.—Mr. J.
 Bell  proposes a suture to be made entirely round.—
 Cylinders of isinglass, or of pasteboard,—rolls of tallow,
 &c.—have been advised to be inserted within the divided
 portion.—The insertion of one extremity of the wounded
 intestine within the other,  and various other modes of
 attempting union, have also been suggested.—The in-
 terrupted suture  appears most likely to be attended
 with success.—Four stitches will be necessary ;  one of
 which should be made near to the mesentery, the others
 at equal distances round the intestine.—The ligatures
 should be suffered to hang from the external wound,
 or should be  cut close, and returned with the intestine
 into the abdomen  ; when the external wound should be
 united as above directed,—See a Treatise  on Hernia,
 by Mr. Astley Cooper, wherein some experiments are
 related, which were made upon animals by Mr. Thom-
 son at Edinburgh, and likewise by himself, which prove
 the success of this mode of practice. 
Q4        WOUNDS OF THE GALL-BLADDER.
         OF WOUNDS OF THE LIVER.
                    DIAGNOSIS.
  A wound of the liver is ascertained to have taken
place by the peculiar dark or biack blood evacuated at
the opening ;—-by the most depressing sickness ;—
frequently by concomitant  jaundice ;—by the  sympa-
thetic pain at the top of the shoulder.
                    PROGNOSIS.
  Small wounds of the liver have been recovered from;
large ones are generally fatal.
                   TREATMENT.
  As in wounds of the other viscera of the abdomen,
the external wound should be suffered to remain open,
until the haemorrhage from the  internal  shall have
ceased ; and the patient should be  placed in  a position
similar to that recommended in wounds of the stomach.
  The accession of inflammation  should be guarded
against, and moderated when present, by a strict anti-
phlogistic regimen,' and by other appropriate means.
  The sympathetic affection of the stomach  should be
obviated by keeping that organ in a  state of perfect
quiet;—avoiding every thing which might excite irrita-
tion;—and by the use of anodyne and emollient clysters.
   OF WOUNDS OF THE GALL-BLADDER.
                    DIAGNOSIS.
  Most excruciating pain ;—an  evacuation  of  bile
from the wound, by vomiting, and by stool.
                    PROGNOSIS.
  It is universally considered fatal.
                   TREATMENT.
  The same treatment  is  applicable to this  as to a
vtound of the H?er  ; which see.  a4*-ve . 
WOUNDS OF THE URINARY BLADDER.      25
  OF WOUNDS OF THE SPLEEN, KIDNEY,
        AND RECEPTACULUM CHILI.
  The first is distinguished by the evacuation of blood
of a remarkably red color:—-it is esteemed fatal.—A
wound of the kidney is ascertained to have taken place
by the passage of blood with urine ;  and afterwards of
pus.—It does not in general terminate fatally.—-When
the receptaculum chili is Avounded, chyle is  said to
flow from the external wound.—It proves mortal, by
destroying  the  organs by which nourishment is con-
veyed to the system.
                   TREATMENT
  Will be  similar in every respect to that already laid
down for wounds of the abdominal viscera.
 OF WOUNDS OF THE URINARY BLADDER.
                    DIAGNOSIS.
  Suppression of  urine, followed by excessive pain
and great distention of the abdomen ;—urine mixed
with blood flowing from the external wound ;—cystitis.
                    PROGNOSIS.
  It generally proves fatal, from the urine escaping
into the  cavity of  the abdomen.—It will  be  more or
less dangerous  as  the wound happens to be above or
below the peritoneal covering of the upper part of the
bladder.
                   TREATMENT.
  It has  been proposed to inject water by the wound,
to obviate the irritating effect of the extravasated urine*
—It has  likewise  been  advised to sew up wounds of
                        D 
26
WOUNDS OF JOINTS.
the bladder ; but  any such attempt must be unsuc-
cessful, from the great retraction of the organ.
  The wound, if small, is directed to be dilated, and the
pelvis to be elevated, so that the wound may be in the
most depending situation.—Inflammation is to be obvi-
ated or diminished by bleeding,—fomentations,—copi-
ous  emollient clysters,—opium, &c. as recommended
for the cure of cystitis;—whilst an accumulation of urine
should be assiduously guarded against by letting  the
patient  constantly wear a  silver, or Smith's flexible,
catheter, occasionally withdrawing it to be cleansed.
           OF WOUNDS OF JOINTS.
                     DIAGNOSIS.
  When a wound has penetrated the cavity of a joint,
there is an escape of synovia ;—the joint soon becomes
swelled and  extremely painful ;—the  edges inflame,
and  put on  a  sloughy appearance ;—there is great
constitutional irritation ;—frequently abscesses form,
and anchylosis ultimately ensues.
                     PROGNOSIS.
  This will  be determined by the size of the joint-
Wounds into large joints sometimes terminate fatally,
from the  extreme constitutional irritation which they
create.
                    TREATMENT.
  Union is to be effected by the quilled or interrupted
suture, according to the situation of the wound.—In
making this,  it is  advisable to guard against the needle
penetrating  the cavity of the joint :»—it should paal
pnly through the  integuments. 
WOUNDS OF THE NECK.             27
  Inflammation is to be obviated by topical bleeding
with leeches ;—fomentations ;—the application of the
steam of warm Avater, and a strict antiphlogistic regi-
men.
         OF WOUNDS OF THE NECK.
               DIAGNOSTIC SYMPTOMS.
  When the trachea or larynx has been wounded, air
rushes copiously through the  Avound, and  in general
there is a loss  of the powers of speech.—If the oeso-
phagus be  Avounded, food  escapes at  the external
opening.
                    PROGNOSIS.
  A wound is in general more alarming when happen-
ing in the  trachea than in the larynx, owing  to the
profuse haemorrhage with which it is usually attended.
—In  many  instances death has been produced by the
blood getting into the bronchia, and producing suffo-
cation.—Wounds of the oesophagus have been almost
uniformly fatal.
                   TREATMENT.
  The Avovind should be united by suture  superficially
inserted, as  directed for wounds of the abdomen, &c.;
and care should be taken, in afterwards  applying ad-
hesive straps, to leave  small openings between each
for  the escape  of air, otherwise  general emphysema
will ensue.
  Where there is great haemorrhage, immediate union
by suture becomes improper.—The receding vessel
should, if possible, be secured: if that be impossible, the
same  treatment should be adopted as to keeping open 
as
WOUNDS OF TENDONS.
the wound, and to the posture of the patient, m in.
wounds of the abdomen.
         OF WOUNDS OF TENDONS.
              DIAGNOSTIC SYMPTOMS.
  The immediate effect  of  a wounded  or  ruptured
tendon, is a retraction of the divided ends  to a very
considerable distance  from each other ;  Avhich, when
the tendon is  superficial, is generally discoverable to
the touch.—The  rupture of a tendon is accompanied
with a sudden pain or shock, similar to that produced
by external  violence__This is more  remarkably the
case in ruptures of the tendo  Achillis.
                    PROGNOSIS.
  When a tendon has been  completely divided, the
oil jury is  seldom productive of serious consequences ;
when partially so, the contrary is sometimes the case,
—See Punctured Wounds, and the Consequences of
Bleeding.
                   TREATMENT.
  The external Avound is to be united by suture ; and
the divided portions of the tendon afterwards made to
approximate.
  The latter is to be effected  by applying compression
upon the body of the muscle, to prevent further retrac-
tion, and by so adjustingthe position of the limb, that the
divided ends may as nearly as possible approach each
other, or effectually come in contact.—In accidents of
this kind happening to the tendo Achillis, this may be
easily done, by means of an instrument invented by the
late Dr. Monro, consisting of a high-heeled shoe, Avith a 
               PUNCTURED WOUNDS.             29

stiff substance running up behind the leg, and confined
by a strap encircling the calf.


OF CONTUSED AND LACERATED WOUNDS.
  In Avounds from  contusion and laceration, there is
little attendant haemorrhage ; but the injury which the
part sustains is in general so great, that a sloughing is
the frequent consequence  :—swelling,  inflammation,
and suppuration, are their constant attendants.
                    PROGNOSIS.
  The danger chiefly arises from a severe inflammation,
and consequent extensive sphacelus.—Tetanus also is
sometimes induced  by laceration of tendons___In other
cases the Avound is to be  regarded  only as a simple
suppurating sore,
                   TREATMENT.
  The chief indications are, to moderate inflammation,
and accelerate the process of suppuration, by leeches ;
—scarifications ;,—warm fomentations, and cataplasms,
—Should sloughing ensue, the same treatment is to
be  employed as  recommended for  mortification :—
opium is hoAvever the most effectual remedy.
  Where the laceration is only slight, an union by the
first intention  may frequently  be effected :—if, upon
trial,  it  should be found impracticable,  suppuration
should  be  promoted by fomentations,  See. &c.   See
Abscess.  '


          OF PUNCTURED WOUNDS.
  Punctured Avounds differ from others, in their having
                       D2 
oO             PUNCTURED AVOUNDS,
been inflicted with a pointed instrument.—They often
produce alarming and even fatal consequences ;  some-
times inducing an inflammation of the internal surface
of an absorbent vessel, and  sometimes by inducing
tetanus by partially dividing a nerve or tendon.  See
Tetanus. fbyn-t*-*jnU Aauar^e.- ^fee<*trt /yo.
  The symptoms produced by the inflammation of an
absorbent vessel are—unusual pain,  coming on a short
time after the infliction of the  Avound, followed by a red
inflamed line, hard to the feel, and extremely painful,
extending upwards, often both upwards and doAvnwards,
along the member, Avhich soon begins to SAvell, and an
extensive inflammation takes place ;  numerous ab-
scesses often form in the course of the absorbents, and
in general the nearest gland becomes enlarged, great
constitutional irritation ensues, the pulse is extremely
quick and hard ; delirium, and in some instances death,
has followed.
                   TREATMENT.
  The most effectual way of preventing  ill conse-
quences from wounds of this nature, is to enlarge the
opening with a lancet or scalpel, and thus convert the
puncture into an incision, which may be united by the
first intention.
  When this has been omitted, compression by bandage
should be had recourse to, in order to facilitate an union
between the sides of the wound.
  Punctured Avounds often become indolent and indis-
posed to heal : in  this case  stimulant injections,—
setons,—dilatation,  8cc. should be employed, and  the
wound treated in every respect as a fistulous ulcer.
  Should inflammation of  the absorbents be the con-
sequence of a  punctured wound,, numerous leeches 
POISONED AVOUNDS.
34
should be applied along its course ; cathartics, refriger-
ants, the saline  medicine, and other remedies proper
for inflammation, should be administered ;—refrigerant
lotions should first be applied to the part, and if these
are unsuccessful, emollient  poultices and hot fomen-
tations.   See the treatment of Inflammation. '
           OF POISONED WOUNDS.
  These are wounds inflicted by poisoned instruments ;
by the bites of rabid animals ; or by the bite or sting of
certain reptiles and insects.
  The effects of wounds  of this kind are various :
some produce almost immediate death ; some dissolve
the crasis of the fluids, and induce passive haemorrhagy,
petechiae, and putrescency of the whole system ; others
are said to  operate  by producing a serene and fatal
sleep ; but the most frequent are those inducing in-
flammation.
                     SYMPTOMS.
   Of the bites of rabid animals.—After the expiration
of a  shorter or longer time, sometimes not until many
months after the accident, the part becomes painful,—
wandering pains  are felt over the body,—great rest-
lessness,—heaviness,—disturbed  sleep and  frightful
dreams;—sudden  startings  or  spasms,—sighing,—
anxiety,—and love  for  solitude.—These  symptoms
daily increase, pains  begin to shoot from the Avounded
part up to the throat, occasioning a straitness and sen-
sation of choaking; an aversion is felt to the swallowing
of Avater or other liquids, which at length arises to such
a degree, that the moment any thing in a fluid form is
brought in contact with the patient's lips, it occasions 
.32
POISONED AVOUNDS,
him to start back  with dread  and horror ; and  the
attempt at deglutition is accompanied with a convulsive
paroxysm.—A  vomiting of bilious matter is an early
symptom ; an intense  hot  fever  ensues, Avith dryness
and roughness of the tongue, hoarseness of. the voice,
and the discharge of a viscid saliva from the mouth,
which the patient is constantly spitting  out; together
with spasms of the genital and urinary organs, in con-
sequence of which the evacuations are forcibly ejected.
—There is extreme anxiety, and irritability sometimes
so excessive that the smallest impression made upon
the body, by the perching of a fly or other cause, fails
not to induce the most terrible convulsions.—In some
instances delirium arises, and closes the tragic  scene ;
but generally the judgment is retained until the pulse
becomes tremulous and irregular, convulsions  then
arise, and nature is, at length, totally exhausted.
  Of the bite of the viper.—.Acute pain and consider-
able swelling of the part, which soon becomes red, and
afterwards  livid ;—disposition to fainting ;—or actual
syncope ;—small rapid, sometimes interrupted, pulse ;
—greatnausea;—bilious convulsive vomitings ;—cold
sweats ;—the skin becomes yellow ;—convulsions ;—<
death.
  Of the bite  of the  rattle-snake.—.Nausea,—a full,
strong, agitated pulsed—swelling of the whole body,—
the eyes much diffused with blood,—sometimes copi-
ous bloody svveats,—and often haemorrhages from the
eyes, nose, and ears.—The teeth chatter, and the pains
and groans of the sufferer indicate his approaching dis-
solution.
   The bite of the adder is  attended with symptoms of
a  similar nature, but  they are much  less violent;
neither does it often prove fatal. 
POISONED WOUNDS.
3:3
   Of smaller reptiles, and ofinsects*—.These in general
 produce local inflammation only ;  which, hoAvever, is
 often very severe : in some instances the bite is produc-
 tive of the  same consequences as punctured Avounds :
 inducing inflammation  of the absorbents, and convul-
 sions from their effect upon the nerves.
   The  effects of the bite  of musquittos, are small
 tumors, attended with so  high a degree of  itching and
 inflammation, that  the  patient  cannot refrain from
 scratching ; by a  frequent repetition of which he not
 uncommonly occasions them to ulcerate.
                    TREATMENT.
            r i.  To prevent tne absorption of the poi-
            J      son.
 Indications.^ n. To counteract its destructive effects
                  Lwhen  already  introduced into  the
                  system.
                         i.
   After the bites of rabid animals.—In order to effect
 this indication, the first step  should be the  application
 of a tight  ligature  above the wound ;  secondly, the
 speedy  and complete excision of the wounded part, in
 situations  where  such  practice  is admissible ; and
thirdly, the long continued affusion  of an alkaline solu-
tion over the excised parts.—The wound should after-
wards be dressed with the unguentum cantharidis, or
other stimulating  ointment,  in order that a discharge
may be kept up'for a considerable length of time.—
When,  from the timidity of the patient, or from the
Avounded part being so situated as to render  extirpation
inadmissible, other means are obliged to be adopted ;
ablution with a solution of caustic alkali, or the appli- 
34
POISONED WOUNDS.
cation of lunar caustic, or kali purum, are most likely
to be attended with success.
   After the bite of serpents, isfc.—The most effectual
means of  securing the patient from  future conse-
quences, is the excision  of  the part, as above recom-
mended.   Where  this is not  practised, a  ligature
should be instantly applied above the wounded part, and
retained there while the latter is washed with the aqua
kali praeparati, volatile alkali, or the spiritus ammonias
succinatus ;—kali purum is  perhaps  the best topical
application.
   The long-continued affusion of cold water has been
recommended, as also  the fat of vipers ;—the  warm
liver of a fowl is now applied  in the East Indies ;—oily
and unctuous applications ;—the firing  of gunpoAvder
upon the wounded part.
   The application  of a poultice of vinegar and vine-
ashes has been successfully used.  Phil. Trans.
   Dr. Mead recommends long-continued suction with
the mouth  defended by oil.
   A poultice of quick-lime, with oil and honey, is said
to have been effectually employed.
   The fresh juice of the plantain is also by some consid-
ered an excellent antidote.
                         n.
   After the bites of rabid animals.—Various are the
modes of treatment recommended by  different Avriters
to fulfil this indication.
   Some  advise  the use  of  stimuli;—Avine,__ardent
spirits,—aromatics,—the  nitrous and other  mineral
acids united with Avine, and administered both by the
mouth, and likewise injected  up the rectum, upon the
first appearance of the disease ;—afterwards, the con- 
                 POISONED WOUNDS.               33

crete acids, as the essential salt of tartar, of lemons, Sec.
or flores benzoes joined with capsicum, to be given in
the form of bolus.
R. Salis tartari essentialis ^j.   Take Chrystalized Carbonate of
                             Potash ^i,
  Piperis Indici gr. viij.       Black Pepper t^r. viij.
  Conserve ros«e q. s.         Conserve of Poses q. s.
Fiat bolus secundaveltertiavel  Make a bolus to be taken every
  quarta quaque hora sumen-    three or four hours.
  dus.
  By Dr.  Rush,  the  antiphlogistic  plan is recom-
mended ;  as copious venesection,—large  laxative clys-
tei s,—diaphoretics.
   Mercury has often been used in hydrophobia ; and
many cases are  related  of its efficacy.  Houlston on
Poisons,  Sec.  Reid, Observ.  on warm and  cold Sea-
bathing.  Rush.
   Musk Avith opium are said to have been successfully
employed.  Dr. Rush.
   Also  Avine and bark in large quantities ;—Avarm and
cold bathing ;—the copious  use of oil internally and
externally;—exciting profuse sweating  by means of
ipecacuanha in small  and frequent doses, or  the pulvis
ipecacuanhae compositus ;—camphor ;—arsenic ;—the
liberal use of vinegar.
   Opium has  been administered in extremely large
doses, to allay  the excessive irritability, Avithout effect.
   The  Ormskirk medicine,—the  Tonquin medicine,
composed chiefly of musk and cinnabar.
   The Carnatic,  Tanjore, or snake pills, composed of
arsenic  and mercury, have been much employed.
   Dr. Powel believes the argentum nitratum to be a
most powerful antispasmodic, and  recommends its in- 
 36              POISONED WOUNDS.

 ternal exhibition in the dose  of one grain every hour,
 increasing it according to circumstances.
   After the bites qfserpents,lsfc.—Emetics;—poAverful
 sudorifics.  Dr. Mead.
   In the  East Indies the folloAving are universally had
 recourse to :
             THE CARNATIC SNAKE  PILLS.
      Take of White arsenic,
              Roots of velli-navi,
              --------neri-visham,
              Kernels of nervalanl,
              Pepper,
              Quicksilver; of each an equal quantity*
 The quicksilver is to be rubbed with the juice of the
   wild cotton till the globules become invisible.  The
   arsenic being first levigated, and the other ingredients
   reduced to powder, are  then to  be added, and the
   whole beaten  Up together, with  the juice of the wild
   cotton,  to a consistence fit to be divided into pills of
   six grains.
   Dr.  Russel gives the following directions for using
these pills : if a person be bitten by a cobra de capello,
mix one of the pills with a little warm water, and give
it to the patient.   After waiting a quarter of an hour,
should the symptoms of infection increase,  give two
pills more ;  should these not sufficiently counteract the
poison, another pill must be given an hour after.  This
is  generally  found sufficient.
   For the bite of all kinds of vipers give two pills ; and
if  the poison  be not counteracted within half an hour
give tAvo pills more:  but if the life of the patient be in
great danger,  four pills may be given. 
feUN-SHOT-WOUNDS.              37
  For the bite of all other less poisonous snakes one
pill, every morning for three days, is sufficient.
  The juice of the garden rue.  Barton, Trans. Amen
Phil. Soc.
  Spiritus ammoniae compositus ;•—vitriolic aether,—
Venice treacle.
  Dr. Temple recommends the caustic volatile alkali,
or spiritus ammoniae succinnatus, to  be administered '
every five minutes.
  Wine given in large quantities.   Dr. Russet.
  The aristolochia, garlic, and various other remedies*
arc occasionally used.---The habilla carthago is in Spain
esteemed a specific for the bite of the scorpion.
  The  local  effects  of the bites or stings of smaller
reptiles and of insects, are relieved by the application
of a solution of opium,—the aqua Jythargyri acetati
composita,—the cremor lithargyri Ph. Chir.,—vinegar
-■—an alkaline solution.
           OF GUN-SHOT WOUNDS.
   According to  Mr. Hunter, these differ in no respect
from contused wounds; their peculiar appearance being-
caused by the velocity of the substance with which they
are inflicted.
                    CHARACTER*
   The appearance of the Avound is peculiar;  its edges
uc black, as if burnt by gunpowder, although in reality
the effect of contusion*  There is  seldom any haemor-
rhage ;  the  inflammation   which  constantly attends
contused Avounds comes on in this species much later
than  usual.—About the second day the parts commonly
                       E 
38              GUN-SHOT AVOUNDS.
become tumid, and the wound pours forth a gelatinous
lymph, when  symptoms  of  constitutional  irritation
arise, Avhich are generally severe ; in extensive wounds
not unfrequently inducing spasm, convulsions, and even
death__A discharge  truly purulent seldom comes on
before the fifth or sixth day ;  Avhen sloughs begin to
separate, and the wound assumes a healthy appearance.
                     PROGNOSIS,
  This Avill depend upon the extent of the injury, the
importance of the part  in which it has been inflicted,
and the degree of constitutional irritation supervening.
—It will  also  be  drawn from the disposition to gan-
grene ;—from the  peculiarity of constitution  by Avhich
consequent symptoms are likely to be aggravated ; as
the patient being  the subject  of organic disease, or
having led an inebrious, dissipated life : in this case the
prognosis Avill ever be  unfavorable.   In general the
danger cannot at first  be  ascertained ; parts will after-
wards  often slough away and produce a fatal haemor-
rhage, or  other consequences, which Avere not at first
suspected to be injured.
                     TREATMENT.
            r i. To   remove  any  extraneous  bodies
_  ,.   .          which may still remain in the wound.
Indications.<    „   ,  . ^  . Q       .       .
            ] n. 1 o  obviate inflammation, and  expe-
            L    dite the formation of pus.
                         i.
  If the situation of the ball, or other extraneous body,
can be ascertained by examination with the probe, or
with the finger, recourse may be had to the forceps in
order to extract it; and if these prove ineffectual, the
wound should  be  dilated.  Should the  ball  have run 
                GUN-SHOT AVOUNDS.              39

superficially beneath the integuments, its course may
generally be detected by  a  red  line in the  cuticle
extending from the external Avound,and in this situation
a simple incision Avill often be sufficient for its extrac-
tion.  If its situation cannot be readily ascertained, little
trouble need be taken upon the  occasion, as numerous
instance's prove that balls may remain imbedded in the
animal solid without producing injurious consequences.
  It has been customary to dilate all gun-shot wounds
in which extraneous  bodies  are still   lodged.   Mr.
Hunter objects to this indiscriminate dilatation, and lays
down the following rules  concerning the propriety of
dilating, and the period at which the dilation ought "to
be  made.—If the wound  be slight, and extraneous
bodies are lodged in it  that may increase consequent
irritation, it should be immediately dilated ;  as  also
Avhere an artery is to be secured  ; where there has been
a fracture,and it becomes necessary to remove detached
pieces of bone, or  Avhere a  protruded part is  to be
replaced ;—but if the injury be severe, the dilatation
should be deferred until after the first inflammation is
over, as by adding an incised to the contused  wound,
tAvo sources of irritation would exist instead of  one.
                        ii.
  By a strict antiphlogistic regimen ;—repeated vene-
section ;—cooling purgatives of neutral salts, with the
addition of antimonium tartarisatum ;—tnc saline med-
icine ;—opium joined with antimony, and other reme-
dies proper for inflammation : which see.
  Locally.—The  application of leeches.—The old
practice of scarifying the contused edges of the wound
has lately been renewed on the continent with success.
—Turpentine,—dilute  solution  of  nitric  acid,—have 
4fl
GENERAL BLEEDING,
also been  advantageously  employed .—.Hot fomenta-
tions ; and, if the inflammation be great, fomentations
of poppies and  cicuta.—Warm cataplasms often re-
peated.
  After suppuration has taken place, Peruvian bark
and other tonics  ;—opium in large  doses ;—the local
use of a dilute solution of nitric acid.
  Where the injury has been so extensive as to require
amputation, much dispute has taken place concerning
the period proper for performing it.
  The circumstances rendering it necessary, are,—
ihjury  done to large joints,—fractures of the bones of
the extremities,—contusion and destruction of  the soft
parts to such a degree as to destroy the circulation of
the blood.—When it is determined  upon to amputate
immediatly after the accident, it will be advisable to
draw a considerable portion of blood from the stump
during the operation, or from the arm soon afterwards,
           OF GENERAL BLEEDING.
  The operation  of blood-letting,  so  as to take blood
from  the  system  generally, is performed either by
opening a vein or an artery : the former is termed
Phlebotomy, the latter Arteriotomy.
  The situations usually chosen  for  a  general  dis-
charge of blood from the system are four x-—the fore-
irm,—the neck,—the temple,—and the foot or ancle.

             I. IN THE FORE-ARM.
  The operator and  patient being placed  in  proper
relative situations. Avhich it Avill be needless to describe. 
                GENERAL BLEEDING.             41

 a lieature is to be made to encircle the arm just above
 the elbow, so as to compress the vein about tAvo inches
 above t.ie part from which the blood is to be drawn ;
 and having been  suffered to remain some minutes, in
 order that a distension may take place  from the accu-
 mulated blood ;  the thumb of the left hand should be
 pressed upon  the vein  made choice of (the basilic or
 cephalic  median  are preferable,) about  two inches
 below the point where the orifice is to be made.  The
 surgeon is now  to  take the lancet, previously bent
 nearly to a right angle, between the finger and thumb
 of his right hand, leaving  at least half of the blade
 uncovered.  He  is  then  to rest his hand on the three
 remaining fingers, while he  pushes the point of the
 instrument cautiously through  the integuments into
 the vein ; when, haA'ing thus pierced its coats, he is to
 carry it forwards in  a direction rather oblique until an
 orifice of sufficient size be made, and then to withdraw
 it in the same cautious manner in which it entered.
   W hen a sufficient  quantity of blood has been drawn,
 the ligature is to be  untied, and the lips of the Avound
 being carefully brought together, a small compress  of
 linen is to be applied upon the orifice j and secured in that
 situation by a roller, passed alternately above andbeloAV
 the elbow, so that when  applied  it may describe the
 figure 8 by crossing at the bend of the arm.

               II. IN THE NECK.
   The external jugular is the vein to be selected for the
purpose, and the most eligible  place for performing the
operation is iibout midway between the clavicle and the
angle of the jaw.— In order to produce an accumulation
of blood, it is necessary to  compress the vessel on each
                       E2 
42
GENERAL BLEEDING.
side of the neck; and this is more conveniently done
by the thumb and finger of the left hand, than by liga-
ature and compress.—The pressure  should be made
about two inches beloAv the part fixed upon for the
incision.—The remaining steps in  the operation arc
precisely similar to those above described, which need
not be repeated.

      III. IN THE TEMPORAL ARTERY.
  The first step in the operation is to expose the vessel
clearly to the vieAv of the operator, by an incision made
through the integuments in the direction of its course.
A partial division of the artery is then to be made trans-
versely, or rather obliquely, when the blood will begin
to flow with great rapidity ; and after a sufficient quan-
tity has been drawn, the haemorrhage is to be stopped,
either by means of  a compress, secured by a bandage
passed around the head, or, as is a more effectual mode,
by a complete division of the vessel; the haemorrhage
ceasing upon the consequent retraction of its extreme-
ties.
               IV. IN  THE FOOT.
  The operation is seldom required to be performed
in this  situation.  When it becomes necessary, the
saphaena vein is to be chosen,and the  same compression
of the veins is requisite as above directed.  To promote
an accumulation  and consequent flow of blood, it is
usual to immerse the foot in Avarm Avater before and
after the  opening has been made.  Adhesive plaster
will in general be sufficient to put a stop to the haemor-
rhage, 
        CONSEQUENCES OF BLOOD-LETTING.      43

    Of the morbid Consequences of Blood-letting.

  I. OF INFLAMMATION OF THE INTEGU-
                    MENTS.
  This will be either phlegmonous or erysipelatous,
according  as certain local or  constitutional circum-
stances may happen to be present.—The symptoms
and treatment have been already described when treat-
ing of inflammation in general.

   II.  OF INFLAMMATION OF THE VEIN.
                    SYMPTOMS.
  The vein  SAvells, and  becomes capable of being
distinctly  traced in its course along the  limb, by an
unusual hardness to the feel, and by  an erysipelatous
inflammation Avhich  runs over it.—Much  pain and
stiffness of the arm is occasioned.—Suppuration often
shortly takes place; most  violent  rigors  come  on,
accompanied with much  fever and irritation.—It has
proved fatal, from the  admixture of pus with the cir-
culating fluids.
                   TREATMENT.
  In order to prevent the extension of the inflammation
along the  course of the vessel, a compress should be
tightly applied upon the vein, at some distance above
the punctured part, in order to effect an union between
its  sides.—Should this be ineffectual, a complete di-
vision of the tube is recommended.—Fomentations and
other local remedies should be assiduously employe^.
See Inflammation^' 
44       CONSEQUENCES OF BLOOD-LETTING.

III. INFLAMMATION OF THE xABSORBENTS.
  For the symptoms  and  treatment,  see  Punctured
Wounds. ' '

 IV.  INFLAMMATION OF THE SUBJACENT
                     FASCIA.
                  .  SYMPTOMS.
  Great pain  referred  to  the  part, extending down-
wards along the arm, upwards to the acromion of the
scapula, and into the axilla ; stiffness and difficulty of
extending the arm.—At first there is  little tumor ; a
considerable swelling afterwards takes  place Avith ery-
sipelatous inflammation, and  sometimes large collec-
tions  of matter form beneath the fascia.
                    TREATMENT.
  Refrigerant lotions ;—fomentations ;—emollient cat-
aplasms, and other local remedies adapted to the spe-
cies and the stage of the inflammation.  See Inflamma-
tion.  '
  If suppuration gnsue, and matter collect beneath the
fascia, this should be immediately divided by an incis-
ion.—After the violence of the symptoms has subsided,
frequent motion  of  the arm  to prevent  consequent
rigidity.

            V. WOUNDED  NERVE.
                    SYMPTOMS.
  Excrutiating pain is sometimes felt immediately
upon  the introduction of the instrument, and this soon
followed by the most extreme constitutional irritation,
—delirium,—convulsions,—tetanus.—At others, a con-
siderable time  elapses before the accession of the symp-
toms. 
            APPLICATION OF LEECHES,          Jlii

                   TREATMENT.
  It is recommended to divide the nerve a short dis-
tance above the  wound, and thereby interrupt the
communication Avith the sensorium.—If bleeding has
been performed in the median basalic vein, a division of
the internal cutaneal nerve will be required : if in the
median cephalic, the external.—They  lie  immediately
above the fascia of the fore-arm, and by  a careful dissec-
tion are readily discovered.   Vide Abernethy's Essays'.

          VI. VARICOSE ANEURISM,
                   See  Aneurism.
           OF TOPICAL BLEEDING.
  The means employed for drawing blood more im>
mediately from  particular parts  consist either in the
application of  leeches,—in  slight incision;}  Avith  a
lancet,—or in the use of the scarificator,
    OF THE APPLICATION OF LEECHES.
  The manner in which leeches are usually applied, is
so avcII known as not to require description.—Success
is rendered more certain by previously drying them, or
allowing them to  creep over a dry cloth ;  the part
also, to attract them,  may be moistened with cream,
sugar, or blood ; and if still  not fastening, it may be
cooled with a cloth dipped in cold water.—Their escape
should be prevented by covering them Avith a small
glass. 
46                    ISSUES,
     OF SCARIFICATION AND CUPPING.
  This  is performed,  where the  part  will admit, by
means of an instrument called the scarificator in Avhich
a number of lancets  are placed in such a manner, that
when it is applied upon the affected part, the whole are,
by means of a spring, pushed suddenly into it, to a depth
at which the instrument has been previously regulated.
  After  scarification has been performed in the  above
manner,  bleeding is promoted by means of glasses,
from Avhich the air has been  exhausted by heat, or by
an exhausting syringe.—The usual mode of applying
heat is by holding the glass over the flame of a  lamp.
An equally or more effectual method is, to moisten a
small piece of tow Avith spirit of wine, to set it on fire
in the bottom of  the  glass, and on  the flame  being
nearly extinguished, instantly to apply it over the scari-
fied part.—The glasses are to be occasionally remoA-ed,
and again applied, until a   sufficient quantity of  blood
has been draAvn.
                   OF ISSUES.
  Issues are artificial ulcers, made Avith the design of
producing  a permanent discharge of purulent matter.
—Three different kinds are iioav in  common use ;  the
blister issue,—the pea-issue,—and the seton.
  The situations chosen for their  formation  will de-
pend  upon the particular morbid slate of the system
for which they are employed.—The  most liecuent are,
the nape of the neck ; the middle of the humerus, or 
THE PEA-T3SUE.               4?
holloAV of the deltoid muscle ; between the shoulders,,
or ribs, and in the inside above or below the knee.
   Objectionable  parts are, wherever there  is  not  a
sufficiency of cellular substance for the protection of
the parts beneath ;—immediately over the belly of a
muscle ;—over a tendon or thinly covered bone ;—near
any large blood-vessel.
            OF THE BLISTER-ISSUE.
   This is formed  by the continued application of a
 small  blister  or vesicant, to  the  part, until the scarf-
 skin is destroyed ;  Avhen being removed, the discharge
 is to be  promoted by milder  applications of the same
 nature Avith the vesicant, alternately  with  some mild
 liniment, according to the degree of the discharge
.required.
                 THE PEA-ISSUE
   Is formed by making an incision Avith a lancet, or by
the application of caustic,
   When the lancet is chosen, the parts  are to be pre-
viously pinched  up Avith the  finger and thumb, and
then cut through until an opening of sufficient size has
been formed.
   The following is the best mode of applying caustic :
The part is first to be covered Avith a piece of adhesive
plaster, in the centre of which a circular hole has been
cut of the size of the intended issue ;—in this hole the
caustic, kali purum, made into  a paste with soap, is to
be placed: the whole is then to be covered with another 
48                   ULCEB.S.
plaster, secured by a bandage, and suffered to remain
for ten or  twelve hours.   Generally  in  two or three
days an escar begins to separate,  Avhen the opening
should be filled Avith the substance made choice of;
this may either be a pea, a bean, small pieces  of  orrfs
or gentian root, orange-peas, Sec.
                  THE SETON.
   The seton is made by means of a needle invented for
that purpose with an attached skein of cotton Or silk :
in inserting it, the parts at which it is to enter and pass
out are to be  previously marked, and a small part of
the skein smeared with some mild unguent.  After
which the needle is to be passed completely through)
and then  separated from the cord, which should be
suffered to remain Avithin the Avound, its ends hanging
from  the  edges.—It is daily to be dressed with a mild
unguent;  and if the discharge should cease, it may be
stimulated with the ceratum cantharidis,—unguentum
Jrydrargyri nitrati rubri,—or ungUentUm sabinae.
                  OF ULCERS.
  By an ulcer is meant a chronic solution or continuity
of the  animal solid ; accompanied with a purulent or
other discharge*
  Ulcers are considered as healthy or vitiated.—The
former state is where the healing process goes grad-
ually on, without interruption, until a cure is effected ;
-—the latter, Avhere some circumstance, either local or
constitutional, forms an impediment to the healing of the 
THE BENIGN OR HEALTHY ULCER.       49
sore ; and hence, according to the nature of the cause,
such ulcers have obtained  various denominations ; as,
the indolent, the inflamed, the sinuous, the scrofulous,
Sec,
   OF THE BENIGN OR HEALTHY ULCEB.
                    CHARACTER.
  Granulations, or little eminences,  arising from  the
surface, of a florid red colour ; small in size, and pointed
at the top ;—the discharge bland,  white, opake ;—.the
edges  thin and even Avith the sore ; being neither in-
verted nor retorted.
                    TREATMENT.
            r  i.  To preserve the healthy state of the
                  granulations.
Indications.-^ n.  To promote cicatrization, Avhen they
                  have attained the level of the adja-
                  cent cutis.
                         I.
  By avoiding  all sources of irritation ;—by perfect
rest ;—an horizontal posture ;—and by the use of mild
and  simple  ointments, as unguentum cerae—ceratum
lithargyri acetati—or the like.
                        ii.
  By compression Avith straps of adhesive plaster (see
the Habitual Ulcer) •—by the application of dry lint to
the surface of the sore ;—by mild astringent ointments
and lotions—the unguentum cerusae acetatae,—cerat-
um  lapidis calaminaris,—lime-water,—weak solution
of vitriolated zinc.
                        F 
no
LOCAL VITIATED ULCERS.
          I.  OF LOCAL VITIATED ULCERS.
      These  are certain deviations  from  the  benign  or
    healthy state above described.   The  causes inducing
    the morbid change, or the impediments to healing, are
    numerous, and require separate consideration.—.Al-
    though greatly influenced, and  often  induced, by the
    general state of the body, as to vigour, debility, irrita-
    bility, &c. they are totally unconnected with any specific
    constitutional taint.
      The  intentions in the treatment  of each  will be
    to obviate the particular cause that has  induced  the
    vitiated state ;  and to restore the ulcer to its  original
    healthy disposition.
    I. Of the inflamed state.
                       CHARACTER.
      The ulcer appears of a dark colour;—it is surrounded
    by an extensive, inflamed, areola,—the surface is cov-
    ered with a brown transparent ichor.
                       TREATMENT.
      Fomentations and cataplasms used until it shall have
    lost its broAvn appearance ;—narcotic fomentations of
    cicuta,—belladonna,—poppies,—digitalis, 8cc.—If the
    inflammation be severe,—leeches to the neighbourhood
    of the sore ;—cooling purges of magnesia Aritriolata, or
    of natron vitriolatum.
    n. Of the irritable and painful state.
                       CHARACTER.
      The margin of the surrounding  skin, jagged, and
— terminating in a sharp and undefined edge.—The bot-
    tom made up of concavities of different sizes,  without
    any appearance of granulations ;—the  surface covered
    with a thin, ichorous discharge,—It is exquisitely pain-
    ful upon the slightest touch. 
LOCAL VITIATED ULCERS.
61
                         CAUSE.
   As it is usually accompanied with a debilitated state
of the part, and is relieved by tonics, it most probably
is that irritability Avhich  is  often the consequence of
weakness.
                      TREATMENT.
   In some instances cold applications succeed best in
relieving  the  pain ;  in others, Avarm ;—fomentations,
therefore, or infusions, previously alloAved to cool, may
be  successively  used ;  of  cicuta,—belladonna,—the
heads »f the white poppy.
   Opium externally  applied, and joined with  camphor
and cicuta and administered internally.
R. Tincturx opii Jij.          Take Tincture of opium Jij.
   Aqune distillate  rxij.         Distilled water 5xij.
Fiat lotio sxpe applicanda.     Make a lotion to be frequently
                               applied.
R. Opii purificati gr. $.        Take purified opium gr. i—J.
   Camphors: gr. v.              Camphor grs. v.
   Bucci cicuts spissati gr. iij.    Extract of cicuta grs iij.
Fiat bolus octavis horis sumen-  Make a bolus to be taken every
  dus.                         eight hours.
  Tonic lotions of zinc vitriolated,—of argentum nitra-
tum, applied with a camel-hair pencil,—or a solution
of natron A-itriolatum.
R. Zinci vitriola'u 3j.          Take Sulphate  of Zinc Zfu
   Aquae distillate 5xij.         Distilled water 5xij.
Solve.                        Dissolve.
S0LUTIO  ARGENTINITRA-  SOLUTION  OF NITRATE OF
       ti  Ph. Chir.                    silver
It  Argenti nitrati ^j.          Take Nitrate of Silver ^i.
   Aqua: distillate 5ss.          Distilled water ?ss.
Solve.                        Dissolve. 
52            LOCAL VITIATED ULCERS.

R. Natron vitriolati jj.        Take Sulphate of Soda gi.
   Aqux distillatae §\ ij.        Distilled water ~vij.
Fiat lotio.                   Make a lotion.
  The unguentum picis.  Kirkland.
  Balsamum Peruvianum, applied on lint, has been at-
tended with good effect.
  Hydrogenous and carbonic acid gasses.  Dr. Rollo.
  Carbon joined Avith opium.   Mr. Home,
in. The sloughing state.
  This is a mortification of the granulations, and may
be the effect, either of a preceding state of high inflam-
mation, or of a debility of the part.—For the treatment;
                 / o.
see Mortification.
iv. The phagedenic  state.   See  Phagedenic  Ulcer,
   page 61.
V. The indolent state.
   In  this  state the part does  not possess  sufficient
vigour for the formation of granulations ; and conse-
quently for the healing of the sore.
                    CHARACTER.
   The ulcer has a peculiar pallid appearance, and is
covered with  a  transparent, glairy fluid, or  with a
lymph, which is  Avith difficulty separated,  and Avhich
gives to it a Avhite appearance.   The edges are thick,
prominent, smooth, and rounded ; there is no appear-
ance  of  granulations, or, if any are perceived, they are
morbidly pale ;—it sometimes  becomes livid, and not
 unfrequently degenerates into gangrene.
                    TREATMENT.
   The internal administration of tonics and stimulants :
 cinchona,—angustura,—preparations of steel, 8cc.
   The inhalation of oxygen gas.  Dr. Beddoes,
   Locally.—The unguentum  oxidi hydrargyri rubri 
LOCAL VITIATED ULCERS.
53
Ph. Ed., or the hydrargyrus nitratus ruber, applied in
form of poAvder ;—the unguentum hydrargyri nitrati.
  Lotions, composed of solutions  of vitriolated zinc,
solution of argentum nitratum, or of hydrargyrus muri-
atus in lime-water ;—the camphorated Avater of vitriol-
ated copper.
AQUA  CUPRI  VITRIOLATI   CAMPHORATED WATER OF
       CAMPHORATA          SULPHATE OF COPPER.
                   Ph. Chir.
R  Cupri vitriolati,           Take Sulphate of Copper,
   Boh  Gallici, singulorum    French Bole, of each zss.
                5ss.
   Camphorx 5J-              Camphor "Zfi.
   Aquae ferventis ftfw.         Boiling water ftjiv.
The boiling Avater is to be added to the other ingre-
  dients, and the liquor filtered Avhen cold.
  A weak solution of nitrous acid.
   Extract of chamomile in solution, externally and in-
ternally.  Collensbusch in Hufeland's Journal.
  Fomentations, formed from angustura,—Swietenia
febrifuga,—oak bark.
  From Avalnut-leaves.   Mr. Home.
  Electricity.
  Arsenic administered both internally and externally.
Mr. Home.
   PoAvders  of  rhubarb,—Colombo,—gentian.   Mr.
Home.
   Compression, by the use of the laced stocking, and
by straps of adhesive plaster.  Baynton.—See Habitual
   Ulcer??'
vi. The fungous state.
   Fungi, arising  from the surface of  ulcers, may be
of two kinds;  the true fungus, of  irregular  spongy
                         F2 
54
LOCAL VITIATED ULCERS.
groAvth ; or the healthy granulations suffered by neglect
to attain too great a height.
                   TREATMENT.
  The application of strong stimuli,  as, solutions of
argentum nitratum.
  Of ammonia muriata in spirit.
  .The pulvis sabinae, or an ointment formed from it;
—the unguentum hydrargyri nitrati rubri.
  Escharotics, of Avhich the best are, the argentum ni-
tratum, and the cuprum vitriolatum.—During the use
of these, dry lint should be kept applied to the surface
of the sore.—When by  some of these  means  the
fungus has  been reduced  in size, adhesive straps and
bandage.
vii.  The callous state
  Consists in a morbid induration, and thickening of the
edges of the sore.
                    TREATMENT.
  Escharotics : the argentum nitratum.
  Sheet lead, so applied as to  press  upon the edges
only.
  Adhesive straps and tight bandage.
  Scarification of the callous parts.
  The unguentum cantharidis confined to the edges of
the ulcer.
vin.  The sinuous and fistulous states.
  These are longitudinal excavations,  formed by mat-
ter insinuating itself in an improper direction ; having
no opening by which it could issue externally.—They
are distinguished from each other by the edges of the
latter being callous ;  of the former, not.
                    TREATMENT.
   Of the sinuous 2tlcer,-—A counter  opening where 
LOCAL VITIATED ULCERS.
So
practicable ;  after  Avhich continued pressure by ban-
dage, or other means.—Should this be impracticable
or unsuccessful, stimulating injections ; as, tincture of
cantharides ;—a solution  of hydrargyrus muriatus, or
of the nitric or muriatic acids ;—a solution of argentum
nitratum applied by means of a feather, or the hydrar-
gyrus nitratus ruber applied on lint.—The introduction
of a seton ;—a free dilatation of the sinus, and conse-
quent conversion into an incised Avound.
   Of the fistulous  ulcer.—Added to  the  above, the
means of treatment before recommended for the callous
ulcer. Am .
IX. The varicose state.
  An indolent ulcer, accompanied Avith a varicose disten-
tion of the brims around the ulcer, and frequently of the
Avhole leg.   It is generally concomitant Avith the cal-
lous  state above described,  and  not unfrequently in-
duced by it.—It more especially occurs in tall men, to
soldiers, to those accustomed to much  fatigue, and
after a change of climate.
                    TREATMENT.
   If the edges  of  the ulcer be callous, these should
first be removed by appropriate means.  See Callous
 Ulcer.—.Should the varix afterAvards continue, recourse
may be had to the use of the linimentum ammoniae;—to
covering the part  Avith oilskin ;—electricity ;—mer-
curial friction or plaster.—If these prove unsuccessful,
it is  advised by  Mr.  Home to obliterate the saphaena
vein above the knee.
   This operation may be performed in either of the fol-
loAving modes : Having exposed the vein clearly to the
view by an incision through the integuments, a ligature
is to be passed around it  by means of  a blunt crooked
silver needle j it is then  to  be tied with  a moderate 
56
LOCAL VITIATED ULCERS.
degree of firmness, and suffered to remain for the space
of five or six days, when it may be removed :  an artifi-
cial valve will thus be formed.   Or the A*essel may be
completely divided, and compression afterAvards made
upon the  part with a compress  and tight  bandage
passed around the thigh.
x. The menstruous state.
  During a suppression of the menses, a  discharge is
often observed to take place periodically from ulcers ;
bearing  an exact resemblance  to  the ciistomary ute-
rine  haemorrhage, and which becomes an obstacle to
their healing.
                   TREATMENT.
  The object will  be to  remove those causes which
obstruct the menstrual discharge.
XI.  The carious state.
  This  is a state of ulceration Avith which there is a
concomitant disease of a contiguous bone.
                   CHARACTER.
  There appear various granular irregularities,  and
considerable prominences, from the interstitial deposit
which takes  place  in the bone.—The fungi are loose,
soft, and of a dark  colour ;—the discharge is a broAvn
sanies of very offensive fetor ;—the edges of the sore
are generally livid.—It has been preceded, and is gen-
erally accompanied, by the peculiar deep-seated pain,
and other  symptoms, wrhich characterize inflammation
and mortification of bone.  See  Diseases of the Bones.''
                   TREATMENT.
  Added to the general treatment of common ulcer,
that proper for exfoliation and necrosis will be requi-
site,  Vide Diseases of the Bones.  * 
        CONSTITUTIONAL VITIATED ULCERS.      57

 II. CONSTITUTIONAL VITIATED  ULCERS.
  Ulcers Avhich have their origin in, or are connected
with, a specific affection of the constitution.
            1.  THE SCORBUTIC ULCER.
                   CHARACTER.
  Tfcc scorbutic ulcer strikingly differs in appearance
from the benign or healthy one first described.—It is of
a brown colour, and covered Avith a sanious ichor ;—the
surface is irregular ;—the texture of the  granulations
loose and  unconnected, often shooting forth fungous
excrescences, Avhich bleed upon the slightest touch.—
It is surrounded by a livid areola, in Avhich petechias
and maculae are frequently observed.—The discharge
is thin and sanious.—It is accompanied by those cir-
cumstances Avhich mark the existence of scurvy in the
system.  See Medical Writers on Scurvy.
                   TREATMENT.
   Constitutionally.—The treatment laid down by med-
ical Avriters for the cure of scurvy.
   Locally.—Vegetable and fermenting cataplasms, of
which various species are recommended.
   The yeast poultice, or cataplasma effervescens Ph.,
 Chir.  See Mortification.
   The carrot poultice :—.
    CATAPLASMA DAl'Cl          CARROT POULTICE,
        Pharm. Chir.
 Boil carrots a sufficient length of time, and mash them
   into a pulp.
   Cataplasm of the bruised leaves of sorrel. Mr. Sand-
ford, Worcester.
   Poultices of the pulp of apples have been success-
fully employed on the continent.
   Pulverized carbon  :  the cataplasma carbonis.  See
 Mortification, 
 58      CONSTITUTIONAL VITIATED ULCERS.

   Carbonic acid gas has been used, by means of an ap*
 paratus constructed for this purpose.
   Oxygen gas.
   Fomentations of angustura.
   The admixture of mel  aeruginis, mel rosae, with a
 small quantity of vitriolic acid.   Lind.           tt
   A solution of nitre in vinegar.  Patterson  on the
 Scurvy.
   The gastric juice of  graminivorous  animals.  Dr,
 Harness.
   At the Liverpool Infirmary, hops are employed as
 an external application.
   A dilute solution of  muriatic and nitric acid in the
 form of lotion, or formed into a liniment with honey.
   The topical use of various powders;—bark,—myrrh,
 —rubige ferri,—Colombo,—rhubarb.  Mr. Home.
   Unctuous applications have been found prejudicial.
   Pressure with adhesive straps.
            II. THE SCROFULOUS ULCER.
                    CHARACTER.
   Its  appearance is that of a pallid and indolent ulcer,
 the surface  of Avhich is covered Avith a transparent
 shining fluid, giving it the appearence which has been
 termed  glassy.—The  discharge is  generally  that
 Avhitish curdled matter, Avhich characterizes scrofulous
 suppuration.   The surrounding skin is often of a deep
 broAvn or livid colour ;—the edges are  thick, retorted,
 and insensible ; often, hoAvever,  they are inverted, and
 exquisitely painful.—It has  been preceded by other
 scrofulous appearances in the system.
                    TREATMENT.
   Constitutionally.—Vide Medical Treatment of Scro-
fula. J***4-i»im*t-'-t  Ira-d*--»*6tc<**»v, %4.<fi . 
CONSTITUTIONAL VITIATED ULCERS.      59
   Locally—Lotions of natural or artificial saltAVater;
—a solution of natron muriatum applied on linen cloths.
   Keeping the parts  immersed in tepid sea-Avater for
the space often or fifteen minutes.
   The camphorated fomentation of muriated ammonia.
    FOMENTUM AMMONIjE MURIATJE CAMPHORATUM.
          Ph. Chir.
R. Fomenti communis fjyj.    Take Common Fomentation^}.
    Ammoniae muriatae *rj.       Muriate of Ammonia ?i.
    Spiritus camphorati ?ij       Camphorated Spirits 5ij.
Whilst the fomentation is hot, the muriated ammonia
   is to be  dissolved in it,  and the camphorated spirit
   added at the instant of its being employed.
   A cataplasm of the quercus marinus, simply bruised,
as a substitute for sea-water.   Mr.  Hunter.
   The topical application of solutions of nitric acid :
R. Acidi nitrici gult. l.        Take Nitric acid drops  l.
    A qu ae font, ijtj'j •              Water ffjij.
F. lotio                     Make a lotion.
   Or of argentum nitratum :
R Argenti nitrati 9j.         Take Nitrate of Silver ^i.
   Aquae distil. Sviij.           Distilled Water 5*'iij.
Solve.                       Dissolve.
   Of  vitriolated  zinc—-Lotions of  lime-water ;__of
Foyer's  arsenical solution.
   The myrrh lotion of the Chirurgical Pharmacopoeia,
      LOTIO MYRRHVE
          Ph. Chir.
R, Tincturae myrrhae,          Take Tincture of Myrrh
   Aquae calcis,  aa 5ij. M.      Lime Water each 5j. Mix,
  Finely levigated burnt sponge ;—rubigo ferri.
  Muriate of barytes.  Dr.  A. Crawford.
  Rubarb.  Mr. Home, 
60      CONSTITUTIONAL VITIATED ULCERS.

  Tinctura cantharidis applied by means of a camel-
hair pencil, or the ceratum cantharidis.
  The ceratum salis cornu cervi:
CERATUM SALIS CORNU CER-  CERATE OF CARBONATE Of
            VI                      AMMONIA.
         Ph. Chir.
R. Salis cornu cervi 5ss.       Take  Carbonate  of  Ammonia
                                         _ 3SS-
   Unguenti cerae ^ss. M.       Cerate Simple 7f>&.  Mix.
             III. THE CANCEROUS ULCER.
                    CHARACTER.
   The cancerous sore is extremely irregular ;—-on its
surface are seen various prominences and excavations,
from one or more of Avhich a haemorrhage is frequently
observed to proceed.—It is attended Avith a peculiarly
burning and lancinating  pain, Avhich is generally inter-
mittent.—The edges are thick, indurated, and  often
exquisitely  painful ;  they are  sometimes retorted,
most frequently inverted.—The  surface is often ren-
dered still more irregular by a cicatrix running across
it.—The discharge is a fetid ichor.
                    TREATMENT.
   The chief intentions in the treatment of ulcerated
cancer are—to correct the fetor of the discharge^-to
allay pain and lessen irritability.
   By ablution with a dilute solution of the oxygenated
muriatic acid.   Dr. Crawford.
   The carrot poultice.
   The fermenting poultice.
   Carbonic acid gas.  Dr. Ewart.
   Pulverized  carbon, or the  cataplasma carbonis Ph.
 Chir. n '
   Arsenic : the arsenicum antimoniatum, with the ad* 
         CONSTITUTIONAL VITIATED ULCERS.      61

dition of opium, is preferable to Plunket's poAvder, or
ivny other arsenical remedy.
              ARSENICUM ANTIMONIATUM.
                     Pharm. Chir
It. Antimonii pulverisati rij.    Take Sulphuret of Antimony in
                                    powder £ij.
   Arsenici pulverisati ?j-        Oxyd f white J of Arsenical.
These  are to be fluxed in a  crucible, and afterwards
   reduced to powder.
   Fowler's arsenical solution- applied as a  lotion, or
mixed Avith meal in the form of poultice.
   An infusion of the lauro-cerasus.   Prof.  Richtcr,
(lottingen.—Dr. Cheston, Gloucester.
   Cataplasm with kali acetatum. 'Mr. Nay lor, Glouces-
ter Infirmary.
   Diluted tinctura fcrri muriati.   Mr. Justamond.
   Argentum nitratum joined Avith opium.
   Oleum lini is said to have been successfully used.
   In  order to .allay pain, fomentations, of  poppies,—fo-
mentations and ointments of cicuta,—of digitalis,—of
belladonna,—of  hyoscyamus, or of nicotiana.—The
application of meal to the surface.—A blister applied
near to the ulcerated part.
             IV. TII_ VENEREAL ULCER.
   Vide Syphilis. %^A"
            V. THE PHAGEDENIC ULCER.
   Of this there  arc  two species :—i. " A sloughing
with ulceration, and each in  succession."—n.  Ulcera-
tion kept up by the irritation of secreted pus; causing
extension of the ulcer Avitliout sloughing.   Vide Ad-
ams. Observations on Morbid Poisons.
                        G 
<>2       CONSTITUTIONAL VITIATED ULCERS.
                    TREATMENT.
  Internally.—For remedies appropriated to the first
species, see Mortification.
  The second species requires hydrargyrus muriatus,
Avith decoctions of mezereon, of sarsaparilla,  cinchona,
and  guaiacum.—Cicuta,—hyoscyamus,—ferrum am-
moniacale,—tinctura ferri muriati,—arsenic.
  Locally.—The topical applications recommended for
mortification are equally Useful to the sloughing pha-
gedaenic ulcer.
  In  the second. species,  fomentations of cicuta and
belladonna ;—the cataplasma effervescens ;—a solution
of opium, or opium in the form of ointment.
R. Tincturs opii 511-          Take Tincture of opium Jij.
   Aquae distillate ?ij.  M.      Distilled water ^ij.  Mix.
R. Opii purificati pulverisati  Take Purified opium in powder

   Unguenti cerx ?j.           Wax ointment ?i.
fiat unguentum. *           Make an ointment.
   A dilute solution of muriated tincture of iron, or am-
moniacal iron.
B. Tincturacferrimuriati 5J-   Take  Tincture  of muriate of
                                           iron Ji.
   Aqute distillatae $viij.   M.    Distilled water ^viij.  Mix,

R. Ferri ammoniacalis gr. xij.  "take Ammoniated iron grs. xij.
   Aquae distillatae ?viij.        Distilled water gviij.
 Solve.                      Dissolve.
   Ofarsenic, or FoAAder's solution made into a cataplasm
 with meal.
   Of argentum nitratum ;—of nitric acid ;—pulverized
 carbon, or the cataplasma carbonis.
             VI. THE CONTAGIOUS ULCER.
   Accounts are given  of this species of ulcer by Hen-
 derson, Ballard, and Edwards, in the Medical Journal. 
              THE HABITUAL ULCER,            63

                   CHARACTER.
  It is peculiar to seamen and soldiers.—It generates
a poison capable of converting other healthy ulcers into
its OAvn nature.—It generally appears in the inner side
of the leg near the ancle.—It discharges a thin acrimo-
nious matter, Avhich excoriates the neighbouring parts.
—It exhales a putrid fetor, and frequently shoots forth
fungous excrescences ;—the leg becomes cedematous
and painful,—the sore bleeds upon the slightest touch,
—putrid sloughs  are frequently cast off, and often a
caries takes place.—If suffered to go on, hectic fever
ensues, Avith colliquative sAvcats, diarhcea, Sec, and the
termination is sometimes fatal,
                   TREATMENT.
  The folloAving remedies are found most efficacious :
The carrot and yeast  poultice ;—the local use of ton-
ics and stimulants, as  lotions of tincture of myrrh with
bark,—of argentum nitratum,—of cuprum vitriolatum;
—camphorated  spirit;—camphorated vinegar ;—hy-
drargyrus  nitratus ruber ;—the  cold salt bath ;—the
application of the juice  of limes.—If irritable and pain-
ful, the cicuta and poppy fomentations.—The internal
administration of bark  Avith steel,  and vegetable fer-
menting substances,


            THE HABITUAL ULCER.
  An ulcer chiefly m  the loAver extremities, which has
been of so long standing that the constitution has be-
come habituated to it, and none of  those  processes
spontaneously take place by which the cure of ulcers is
effected.
                   TREATMENT.
   The edges of the wound are to be made as nearly as 
54
BURNS AND SCALDS.
possible to approximate by means of adhesive straps—
Mr. Baynton has published on this method of cure : he
directs the limb to be encircled with straps of adhesive
plaster  for the space of an inch  both above and below
the sore ;  the straps  should be about an inch and an
half in breadth, and made of the emplastrum adhesivum
spread on  calico.   After their application, the whole
of the affected parts should be defended with pieces of
soft calico  ; a calico bandage is then to be applied from
the foot to the knee, with as much firmness as the pa-
tient  can bear ; and lastly, that part of the  limb Avhich is
the seat of the ulcer, is to be well moistened with cold
'spring water poured from a large teapot.—-The cure is  ,
assisted by moderate mechanical motion and electricity.
—During  and after the healing of the ulcers,  the pa-
tient should  use  frequent mercurial purges.—Issues
are also recommended.—In persons Avho are the sub-
jects of chronic visceral  disease, the suppression of
such long-accustomed evacuations Avill be improper.
           OF BURNS AND SCALDS.
  The injury produced by the application of intense
degrees  of  heat  to the surface of the body may be in
three different states :—First, Avherein a state of sim-
ple inflammation is produced Avithout a destruction of
the cuticle ;—secondly, Avhere th#cuticle is either ele-
vated in the  form of vesicles containing a serous fluid,
or totally destroyed ;—.and  thirdly,  where  the  injury
has been so  great as to destroy the subjacent cellular
or muscular substance.
  There is generally excessive  pain, and if the burn
or  scald be extensive, a  fever is induced,  Avith an 
                 BURNS AND SCALDS.              65

extremely rapid  pulse,—dry foul tongue,—flushed
countenance,—sometimes extreme irritability and rest-
lessness,  at  others torpor and  often  coma.—It not
unfrequently proves fatal.
                    TREATMENT.
   Tavo different and opposite modes have of late been
proposed for the treatment of burns, each of Avhich has
numerous advocates.
   Sir  James Earle recommends the use of cold appli-
cations, and the antiphlogistic treatment:  he directs
the  parts  to be immediately immersed in cold Avater,
in Avater cooled by ice, or that ice or snow, if either can
be procured, should be applied to them.             •
   Mr. Kentish, on the contrary, advises the topical and
internal administration of powerful stimuli.-—His plan
of treatment is as follows: The parts are first to  be
bathed tAvo or three times with spirit of Avine, Avith
camphorated spirit, or spirit of turpentine made Avarnr
by standing in hot Avater ;—after Avhich a liniment is to
be applied, composed of the unguentum resinae flavae
softened Avith turpentine.   At the second dressing ab-
lution  Avith proof spirit, and thus successively milder
applications, till the cure is effected.
   Internally ; aether, brandy, opium ; afterwards, Avine,
ale, &c. until suppuration takes place,  when the most
bland applications are  to be substituted for the stimu-
lating
  Mr.  Cleghorn, abreAver at Edinburgh (see Medical
Facts and Observations, vol ii.), has treated burns with
success, by applying, in the first place, vinegar, until the
pain abates ;—secondly, an emollient poultice ;—and
thirdly, as soon as any secretion appears, by coverine;
the sore with powdered chalk.
                       G2 
66
THE WHITLOW.
   Lime-AA'ater, with linseed oil, has been often used :—
                LINIMENTUM OLEOSUM.
                       Ph. Guy.
 R. Olei'seminis lini 5jss.      Take Linseed oil ^iss.
   Aqux c-dcis 5iij.  M.        Lime water £iij.
 Fiatlinimentum partibus affec-  Mix
   tis applicandum.
   Dr.  UnderAvood advises the application of liquefied
 soap.
   The CATAPLASMA RADICIS SOLANI TUBEROSI of the
 Pharmacopoeia  Chirurgica,  Avhich  is  raw potatoes
 pounded to a proper degree of fineness, may be advan-
 tageously employed.
   Perhaps  the  best application, immediately after the
 accident, is spirit of Avine, united Avith the aqua lithar-
 gyri acetati composita, or aqua calcis.
 R.  Aquae lithargyri  acetati  Take compound solution of ace-
           compositae 5xiij.            tite of lead ?xiij.
•                  .     "7--■ -     t.   r       ^' - -
    Spiritus vinitenuioris znj.    Proof spirits rnj.
 Fiat lotio.                    Make a lotion
   If much febrile heat ensue, gentle laxatives, and the
 saline medicines.
   To alleviate  pain, Avhen excessive, the internal and
 external use of opium.
   If the injury have been very severe, suppuration, and
 tn.e separation  of  sloughs, should be promoted by ap-
 (. king fomentations and emollient cataplasms.
   A dilute  solution of nitric acid is also in this state an
 excellent application.  See page 59.


     OF THE PARONYCHIA, OR WHITLOW.
   The paronychia is a phlegmonous tumor, occupying
 the extremity of the finger.—From its different seat, it
 h^s. been classed into four species, 
THE AVH1TLOW.
67
   The first species is situated around the nail, immedi-
ately under the cuticle.—It appears in the form of a
small swelling, attended with a degree  of redness and
some pain, at the root or at one corner of the nail;—the
skin is very little discoloured ;—it quickly advances to
suppuration, Avhen the cuticle appears almost transpa-
rent.—After the contents of this little abscess have been
evacuated, the ulcer soon spontaneously heals.—The
loss of the nail is hoAvever-in some  instances, through
improper treatment, the consequence of the disease.
                    TREATMENT.
   Lotions of camphorated  spirit, or a solution of am-
monia muriati, to resolve the inflammation.
It. Ammoniae muriatae  5j.     Take Muriate of ammonia: 2h
   Aceti communis ?ij          Vinegar ?ij.
   Spiritus vini tenuioris 2j.     Proof spirit 5i.
   Aquae distillatae ?xij.        Distilled water ?xij.
Fiat lotio.                   Make a lotion.
   If suppuration ensue, marked by one Avhite, promi-
nent spot, the cuticle should be immediately removed,
and an exit given to the contained fluid.
   The second species is in the cellular membrane, at
the extremity of the finger.—Its attack and progress
are  more severe than  in the cutaneous, and attended
Avith more acute throbbing pain ; the sAvelling is more
uniform, and  there  is a considerable elevation of the
skin ; the suppuration  is more sIoav, and matter often
insinuates itself beneath the nail.
                    TREATMENT.
  Long-continued immersion  in  warm water ;__the
application of spirituous and saturnine lotions, and the
lotion  of  ammonia  muriata  (above).—If these fail in
effecting a resolution of the tumor, an early and free
incision should be made through the integuments, and 
68
THE WHITLOW.
carried to the bottom of the diseased part ;  after which
the blood may be suffered to Aoav for some time, and
the opening treated as a common wound.
   The third species is seated  underneath the sheath of
the flexor tendons of the fingers.—It is infinitely more
violent, and dangerous, than  the two preceding.—The
matter  meeting with greater difficulty  in finding its
way outwards, often  insinuates itself among the ten-
dons, and gets into the  hand,  where a fluctuation is
generally felt under the aponeurotic expansion of the
palmaris muscle.—The pain is generally  most excru-
ciating, and extends along the internal condyle of the
humerus up to the axilla, often occasioning  a  painful
tumefaction of the whole  arm :  there is great inflam-
mation of the parts ; much restlessness ; a considerable
degree  of fever, and more or less delirium, according
to the greater or less violence of the complaint.
                   TREATMENT.
   An early incision through the strong ligamentous
bands, which confine the tendons.—Should the collec-
tion of  matter have already extended into  the palm of
the  hand, the aponeurosis of the palmaris should be
cautiously,  yet freely, divided ;—opium should be ad-
ministered to allay pain and  irritation, and the fever, if
considerable, treated as an idiopathic complaint.
   The fourth species is Avhere the  matter is  formed
beneath the periosteum, or where the bone itself is dis-
eased.—In this, the pain is much more deeply seated,
and, though not so acute, is more distressing than in the
former  species; in some cases so much so, as early to
induce fever and delirium.—The disease is more local
than the preceding ;  the arm and hand being little af*
fected,aud the sAvelling of the part much less conside 
THE BOIL.
69
rable ;—the finger frequently becomes livid, is covered
with little blisters containing  a bloody serum, and
threatens mortification.
                    TREATMENT.
  When the above described violent pain occurs at the
extremity  of the finger, and proceeds to induce fever
and delirium, it will be advisable, although  no external
marks of disease may be present, to make an incision
at the extremity, or a little to the side of the finger, and
carry it down to the bone ; by this means sometimes a
small portion of dark-coloured sanies will be evacuated,
at others  blood alone—If this  prove unsuccessful, it
has been  advised to amputate  the finger :  this will,
however,  in the early stage seldom be necessary.—
When the bone is carious, recourse must be had to the
treatment recommended for necrosis.   It  will m gen-
eral soon become loose,  and  with a forceps may be
AvithdraAvn from the sore parts  ; after which, lint may
be interposed between  the  edges of the wound,  that
granulations may arise and fill up the cavity.
       OF THE FURUNCULUS, OR BOIL,
                    CHARACTER.
  A hard, circumscribed, exquisitely painful phlegmo-
nous tumor, generally appearing under the figure of a
cone, the base of which is considerably beloAV the sur-
face of the -surrounding skin.—Upon the most prom-
ineia  part of the boil, there is commonly a Avhitish or
livid pustule,  exquisitely sensible to  the touch, and
immediately beneath this is the seat of the abscess.—
The matt'i is generally slow in forming, and is seldom
found to exist in considerable quantity—Its seat is the 
ro
THE CHILBLAIN.
cellular  membrane of any part of the body :  its stz^
seldom exceeds that of a pigeon's egg.
                    TREATMENT.
  Suppuration  should be promoted by  cataplasms,
fomentations, the  long  exposure of the  part to the
vapour of hot water ;—by stimulant plasters, and  other
means laid doAvn for the treatment of sIoav suppuration;
see Abscess.'
  Where there is a disposition in the body to the
formation of boils, Peruvian bark, preparations of steel,
acids, and sea-bathing, have been found serviceable;
as also the use  of diuretics, as cream.of tartar,  nitre,
Rochelle salt, vegetable and mineral alkalies.—Per-
son'* Principles of Surgery.
      OF THE PERNIO, OR CHILBLAIN.
                    CHARACTER.
  A painful inflammatory  SAvelling, sometimes of a
florid, more frequently of  a deep purple, or leaden
colour, appearing in the fingers, toes, heels, and other
extreme parts of the body.—The pain is not constant,
but rather pungent and intermitting ; accompanied with
an insupportable itching and sense of tingling ; espe-
cially Avhen exposed to heat.—The part often becomes
cedematous, and ulceration not unfrequently super-
venes ; in which case a vesication, or simple separation
of the  cuticle,  is first observed, and beloAv this there
appears a  foul, irregular, painful ulcer, which, by
neglect, will increase to a considerable magnitude.—'It
sometimes  terminates in gangrene.
                      CAUSE.
  Exposure to severe degrees of cold, 
THE CARBUNCLE.
*'l
                   TREATMENT.
  Preventive.—Carefully defending , the parts from
external cold by Avarm clothing, or the application of
adhesive plasters ;—giving tone and action to the parts
subject to  the  disease,  by exercise or friction ;—
hardening the cuticle, and promoting the circulation,
by stimulants ;—as alkohol,—spirit of turpentine,—
lotions of a saturated solution of natron muriaticum,--
of ammonia muriata.-—or of alum.
  In  the inflamed state.   The topical application of
camphorated spirit, joined Avith vinegar ;—a solution
of alum, or cataplasm Avith the addition of pulverized
alum ;—spirit of rosemaiy, to which a small portion of
spirit of turpentine has been added.
  In  the  ulcerated state.—The  treatment recom-
mended for indolent ulcer ; Avhich see. *v
     OF THE ANTHRAX, OR CARBUNCLE.
            CHARACTER AND SYMPTOMS.
  A deeply  seated, hard, immoveable, and distinctly
eircumscribed tumor ; generally appearing in the pos-
terior parts of the body, and most frequently attacking
people above the middle age, and luxurious livers.—
About its  centre it is of a dusky red, purple, or livid
colour,  but is  much paler,  and often variegated, to-
wards its circumference.—There is often an extensive
areola of a broAvnish hue.—It is accompanied with an
intensely painful sense of burning ;—small purulent
vesications or pustules  appear, which Avhen ruptured,
evacuate a dark coloured sanies, and often discover a
sphacelated base. 
^
j?_-           CONTUSIONS AND SPRAINS.

  It usually commences Avith a small  pimple Avhich
runs deeper  and deeper into the  cellular membrane,
until the base  becomes extremely broad.—In the be-
ginning, it is  sometimes accompanied Avith  symptoms
of general inflammation,  but  more  commonly  with
rigors,—sickness,—faintings, succeeded by great pros-
tration of strength,—.languid pulse,—and symptoms of
of typhus.—It not  unfrequently  degenerates into  a
sloughing  ulcer.—It is sometimes accompanied Avith
a miliary eruption, or with  petechiae dispersed in dif-
ferent parts of the  body.—It not unfrequently degen-
erates into a sloughing ulcer.
                    TREATMENT.
  Internally,—Nutritive generous diet,—Avine,—Peru-
Arian bark,—preparations of steel, and other tonics,—
opium,—aromatics, &c.
  Locally.—Lotions of vitriolated zinc, or of a solution
of tinctura ferri rnuriati.—Fomentations of oak bark,—
or the camphorated fomentation of muriated ammonia,
page 59.—Should sloughing supeiwene, recourse Avill
be had to the appropriate treatment.  See Mortified'ion.
       OF CONTUSIONS AND SPRAINS.
  A contusion is an injury to the soft parts of the body,
occasioned by a  fall,  bloAv, or by  violent pressure,
without Avound or loss of substance.—It is usually aci
companied Avith  an effusion of blood, or other fluids,
from the  rupture of some  of the  small vessels ; by
which the parts acquire  a  deep red, leaden, or livid
colour.—When the ii jury has been severe, a sphacelus
is not an unfrequent  consequence. 
CONTUSIONS AND SPRAINS.
73
   A sprain is a painful and inflammatory lo™.! affection,
 OAving to the over-distention of a tendon or ligament.—.
 It most frequently  happens in the wrists, knees, and
 ancles.—It is generally accompanied with an extrava-
 sation of blood ; giving to the integuments the discol-
 oured appearance above described.—Injuries of this
 kind are sometimes accompanied with loss of motion for
 many Aveeks ; and often a thickening of the parts takes
 place, Avhich  continues for the remainder of life, and
 produces, at particular times, and upon any exertion,„
 recurrence of severe pain.
                    TREATMENT.
   Immediately after the accident, long-continued im»
 mcrsion of the part in Avater heated to 112°.—The ap-
 plication of leeches ;—restringent applications ; such
 as vinegar, in the form of cataplasm, made by mixing
 oatmeal and vinegar ;—camphorated spirit;—lees of
 red Avine ;—the embrocation of ammonia :—
  EMBHOCATIO AMMONITE      EMBROCATION OF AMMO-
        P/iarm. Chir.                   nia.
 R Saponis mollis X\j.          Take soft soap Jij.
   Spiritus vini tenuioris 5,j-     Proof spirits 5i.
 Digere, dein adde—           Digest, and add—
   Aquae ammoniae acetatae ?j.   Water of acetite of ammonia
                                         |i.
   Aquae ammoniae purae Jij.    Water of ammonia X\],
  Where a weakness remains behind in consequence
of a sprain, pumping cold Avater every morning upon
the part, and Avearing a calico bandage to support it,
 will be the most effectual means of invigorating it.
H 
74
OF TUMORS.
        OF SARCOMATOUS TUMORS.
  These are ATascular tumors arising from a morbid
growth of skin.—They  generally begin Avith a small
warty projection, AA-hich soon becomes pendulous, and
sometimes, though not often, enlarges to a considerable
size,—As the tumor increases, and becomes vveighty,
it draAvs the skin from the neighboring parts, and a
pedicle is thus formed.—In advanced life it becomes
smooth, livid, and in some instances has degenerated
into cancer.
  Of this species are navi mateYni, or original marks,
which are small excrescences, sometimes hardly arising
above the cuticle, at others considerably protuberant;
—they are  firm, fleshy, and very vascular, consisting
solely of a congeries of Aressels.
  Smaller tumors of the sarcomatous kind are denom-
inated warts : these are usually confined to the hands
and fingers, and pudenda, where they are often situated
in great number, and  folloAv as a consequence of the
venereal disease, though not themselves partaking of
the venereal taint.
  Corns are small tumors of a horny nature, situated
on the feet and toes : they consist in a diseased state of
the cuticle produced by pressure.
                    DIAGNOSIS.
  Sarcomatous  tumors are  distinguished from  all
others by the hardness of their texture ;—by their
great vascularity;—.by the absence of pain and inflam-
mation. 
SARCOMATOUS TUMORy.             75
                     TREATMENT.
   When small in  size, they are to be removed, either
by strong stimuli,  or by escharotics, as they happen to
be more or less firm in texture : previous to the appli-
cation of these, the cuticle may, if indurated, be softened
by immersion of the part in Avarm Avater, or by foment-
ations or emollient cataplasms.
   The stimulants  commonly employed for this purpose
are savinc poAvdcr, or the compound poAvder of savinc
or of rhubarb.
rULVIS RHABARBARI COM-    COMPOUND POWDER OF
     POSITLS.  Ph. Chir              RHUBARB
R. Pulveris rliabarbari,        Take Jihubarb 1 powder—
   ———-— ipecacuanha;,  sin-     Ipecacuanha j equal parts-.
     gulorum partes  xquales.
Fiat Pulvis.                  Make a powder.

  PULVIS SABINJE COMPOS1-   COMPOUND POAVDER Of SA"
       tus.   Ph Chir.                  vine.
R. Pulveris sabinae,           Take Powder of savine,
   --------seruginis, singulo-            ■■  of sub-acetite of
     rum partes aequales.               copper fcervgoj
Fiat pulvis.                  .Mike a powder.
   The tinctura ferri muriati is sometimes successful,
   A solution of hydrargyrus muriatus in alcohol:
R. Hydrargiri muriati Jj.      Take Muriate of mercury  "Z).
   Spiritus vini rectificati rij.     Alcohol  2jij.
Fiat solutio.                 Make a solution.
   The solution of argentum nitratum, page 51.
   A solution of ammonia muriata :
R. Ammonix muriata: 5j.     Take Muriate of ammonia gi.
   Spiritus vini rectificati q. s.     Alcohol q. s.
ad solutionem ejus            to make a solution.
   As  escharotics, argentum nitratum,—antimonium
muriatum j—-arsenic = 
76            STEATOMATOUS TUMORS,

  When they have attained a large size, removal by lig-
ature, or by excision, will be advisable ;—if pendulous,
and hanging by a small base, the former mode is prefer-
able ;—if, on the contrary, the base be broad, excision-
Avill be the  only  mode of extirpation :  this consists
simply in a cautious dissection of the tumor from the
surrounding parts.
  Corns should be secured from pressure by means of
a piece of thick adhesive plaster ; in the centre of which
a hole has been made for the  reception of the project-
ing part.   This,  Avith frequent immersion in Avarm
Avater, and occasional  paring, has often been found to
remove them.—An effectual  mode of extirpation is  by
the application of a small blister ; the effect of which
•vill generally be to raise them with the cuticle.


        OF STEATOMATOUS TUMORS.
   These  consist in a morbid groAvth of the adipose
membrane : their first appearance is usually a small
excrescence,  soft and cedematous ;  this gradually  in-
creasing,  often attains an  enormous size.—They are
free from pain and inflammation and discolouration of
the cuticle, and occasion inconvenience to the patient
only by their bulk ; sometimes, hoAvever, after they
have become extremely large, inflammation and ulcer-
.ation take place.—They are soft to the touch ; feeling
not unlike the omentum contained Avithin a hernial sac,
                     DIAGNOSIS.
   The characteristic marks are—the softness of their
, texture ;—their great bulk ;—the absence of pain and
 inflammation., 
ENCYSTED TUMORS.              TV
                   TREATMENT.
  Removal, either by ligature, or by excision : the lat-
ter mode is preferable, except the tumor is extremely
pendulous, and hangs by a small pedicle.—The opera-
tion  of excision is in general a simple one, except in
certain situations, as in the neck, Avhere great delicacy
and  caution are required, to prevent doing injury to
contiguous important parts.—In  performing it, suffi-
cient integument should be saved to effect a consequent
union by the first intention.
           OF ENCYSTED TUMORS.
  The true encysted tumor  is a collection of matter
contained Avithin a cyst formed by adhesions in the cel-
lular  membrane.—From the  nature of its contents, it
has obtained different appellations, as atheromatous,
mcliceratous,  Sec.—Its seat is the cellular membrane
of any part of the body : its size usually that of an egg ;
and it seldom or never increases to a great bulk.—It
begins Avith a distinctly circumscribed swelling, hard to
the feel, and unattended by  pain.—It gradually gets
larger and larger, until some slight inflammation comes
on, Avhen it becomes in  a small degree painful, and a
fluctuation is  soon aftenvards distinctly perceived.—
As it slowly enlarges, the vessels of the integuments
become AaTicose, and in some  instances, though  not
often, slightly  livid.  t
                     DIAGNOSIS.
  It is distinguished from common abscess by the ex-
treme sloAvness of its progress  to maturation, and by
the absence of pain and inflammation.
                        H2 
;8
THE GANGLION.
                    TREATMENT.
  Various stimulating applications have been recom-
mended in order to induce suppuration;  the chief of
which are—
              EMPLASTR- M EUPHORBII.
                    Pharm Chir
R. Picis Burgundicae 5iv.      Take Burgundy pilch jiv.
   Euphorbii Jss.             Enphorbeum ^ss.
   Terebinthinae vulgaris q. s.   Common turpentine q. s.
  The emplastrum cumini;—the  emplastrum ladani
compositum, and lithargyri compositum.
   Electricity ;—dry cupping ;—salt  brine v—diluted
volatile spirit.
   It has  also been customary to evacuate the matter
by seton ; but the most effectual mode of remoAal, and
that now usually practised, is extirpation with the  knife.
—In performing  this, the cyst,  still containing the
matter, is to be carefully dissected from the surround-
ing muscular and  cellular substance, and  sufficient
integument is to be saved to effect an union by the first
intention.
              OF THE GANGLION.
  A ganglion is  a tumor formed by a  preternatural
collection of fluid within the vagina of a tendon or a
bursa mucosa.—It is situated under or  between ten-
dons, and generally near to a joint.—It begins with a
small, moveable, elastic swelling, attended with little
or no pain or discolouration of the cuticle.—It seldom
attains a large size, and  in general shows  no sign of
inflammation ;  yet sometimes an inflammation super-
venes, when, adhesions not  unfrequently take  place 
BR0N0H0CELE.
79
among the tendons, by which their motions are often
impeded, and the joint rendered useless.
                   TREATMENT.
  The removal of the tumor may first be attempted
by means of pressure ; for this purpose the application
of sheet-lead has most frequently proved effectual.—
Stimulant applications also sometimes produce an ab-<
sorption of the fluid ; of these the best are—mercury,
applied by friction,—blisters,—a solution of ammonia
muriata,—electricity.—If  these  prove  unsuccessful,
the collected fluid may be evacuated by a small opening
made with the point of a lancet.—After  the contents
have been thus let out, the orifice should be immedi-
ately closed, and pressure applied to produce an adhe-
sion between the sides of the  sac.—In some instances,
the cyst maybe detached and drawn out with the tenacu-
lum ; but in attempting this, great caution is required,
especially if the tumor be situated very near a joint.—
Collections  of this kind have often been removed by
the same cause that induced  them ;  i. e.  a bloAv, or
other accidental injury : hence it has been proposed to
employ these artificially, as a  mode of cure.
              OF BRONCHOCELE.
  A tumor on the fore  part of the neck, formed by an
enlargement of the thyroid gland.—The progress of
the swelling  is extremely gradual, and in general the
skin long retains its natural appearance.—It is at first
soft, but as it advances in size it acquires a e>,reat degree
©f hardness ;  the skin becomes of a broAvnish or copper
colour, and the veins of the integuments are varicose.
—The face is subject to frequent  flushing ;—the pa- 
.SO                  BRONOHOCELE,
tient complains of frequent headaches ;  and likewise of
pains shooting through  the  body of the tumor—It is
often accompanied with  hysteric affections,
                     CAUSES.
  The inhabitants of Derbyshire, and other mountain-
ous parts  of our own country ; and those of the Alps,
and adjacent mountains on the continent; are peculiarly
subject to this disorder.—Among the latter it is known
by the name of goitre, and its origin is  ascribed to the
use of siioav water.—It  is considered a scrofulous af-
fection of the gland.
                   TREATMENT.
  Locally.—A  solution  of soap and saponaceous lini-
ments ;—the emplastrum hydrargyri  ;—the emplas-
trum ammoniae, and emplastrum  ammoniaci cum hy-
drargyro ;—mercurial friction upon the part.
  Internally.—The medicine  almost universally em-
ployed for the cure of this disease is burnt sponge,—
The mode of administering this remedy employed by
Dr. Bate  of Coventry,  as given by  Mr. Wilmar,  is as
folloAVs :
  The day after the  moon  hath  been at the full, the
patient is to take a vomit, and on the succeeding day a
purge; on the  third night,  a bolus, composed of ten
grains of calcined sponge ; and the like quantity of cal-
cined cork, and burnt pumice-stone, is to be  placed
under the tongue, and being alloAved to dissolve  very
gradually, is to be swalloAved,  This is to be repeated
for seA-en successive nights, and in the forenoon of each
day a poAvder is to be giAen,  consistmg of floAvers of
chamomile, gentian-root, and seeds of lesser centaury,
each in poAvder five  grains.  On the  eighth  day the
pur.ge  is to be  repeated; and on  the wane of the stt S 
BRONCHOCELE.
91
ceeding moon the same process is directed to be re-
commenced, unless the disease is cured before.  The
vomit  is only to  precede the first course of the med-
icine.
  Dr.  Cheston  has  found the folloAving plan, which is
an improvement upon the Coventry receipt, successful
in numerous cases before the structure of the part has
been too morbidly deranged.—A dose of calomel, one
or tAvo grains,  must be  given for three  successive
nights ; and on the following morning a purge.  Every
night  afterwards, for three weeks, half a drachm of
calcined sponge,  formed into a troche with mucilage
of gum Arabic, is to be put under the tongue, and al-
loAved to dissolve  gradually ;  Avhen the solution is to be
swalloAved.  At the expiration of this time  the Avhole
is to be repeated.
  By  Mr.  Prosser  the  folloAving  powder is  recom-
mended to be  taken an hour before breakfast,  for  a
fortnight or three Aveeks ; and to  be repeated every
alternate fortnight; together with the use of the pilula.
hydrargyri administered at night :
R. Hydrargyri sulphurati rub-  Take lied sulphuret of mercury,
       ri,
   Millepedis inpulveris triti,     Mellepedes in powder,
   Spongix usiae singulorum    Burnt sponge, each gr. XV.
       gr. xv.  Misce         Mix.
   Sulphurated potash dissolved in  water has been em-
ployed Avith  success, by Dr. Richer, in cases where
calcined sponge had failed.
R. Kali sulphurati 3ss.        Take Sulphuret of potash Jss.
    Aquas distillai ae  j£ij          Distilled water j-juj
 Fiat solutio in dies suw.en.da.   Make u solution to be taken in
                              the course of the day. 
S$  ENLARGEMENTS OF THE ABSORBENT GLANDS.

                  OF CANCER.          ha-m*
  Vide Diseases of the  Breast;—of the Testicle,—
Cancerous Ulcer, Sec.—Avhere the symptoms and treat.
ment of cancer, as appearing in glands, are amply enu-
merated.


 OF ENLARGEMENTS OF THE ABSORBENT
                    GLANDS.
  As the absorbent glands of the neck are those Avhich
most frequently become diseased, a description of these
in their diseased state will serve as an example of the
rest.
                    symitoms.
  The tumor is  commonly preceded by catarrh from
exposure to cold ; during the continuance of Avhich the
glands behind the ear become sore and  painful ; from
these an irritation is communicated to the lymphatics
at the  side of the neck, Avhen  a tumor commences,
which, in constitutions so predisposed, often paves the
way for one of the most formidable diseases  of Avhich
the human body is susceptible ; by proving the exciting
cause to a long  train  of scrofulous affections.'—The
gland continues to enlarge, but its progress to matura-
tion is  extremely sIoav ; there is  seldom any considera-
ble pain, neither is that degree of inflammation present
Avhich  is common to abscess in  general ; and it often
increases to a large size before fluctuation is percepti-
ble ;—the skin acquires a broAvn or  livid colour.—At
length, and if preventive means are not duly taken, ul-
ceration of the integuments ensues,  and a thick curd-
like matter, or white coagula floating in a thin fluid, is
discharged. 
    ENLARGEMENTS OF THE ABSORBENT GLANDS.  83

  An inflammation of the absorbent glands of the neck,
by causing  an irritation of the surrounding cellular
substance, sometimes gives rise to the formation of a
steatomatous  or  sarcomatous tumor,  Avhich often en-
larges to a considerable size.   This generally becomes
pendulous,  and sometimes so large as to  extend to
the shoulder.—It is more vascular than the common
stcatoma, and from the constitution of the patient does
not appear to originate in a scrofulous affection.
                      CAUSES.
  When the tumor assumes the above character, it
may be  universally deemed  a scrofulous affection—
Enlargements of the glands from other causes almost
universally terminate by resolution ; or, if suppuration
supervene,  the progress  is rapid as in the common
phlegmon.
                    TREATMENT.
  Locally.—In the  incipient state, discussion should be
attempted by the application of leeches and cold lo-
tions  ; as, the solution of vitriolated zinc, page 51,—a
solution of alum,—or the aqua lithargyri acetati com-
posita, with the  addition of about a  quarter part of
vinegar or camphorated spirit.—If the  inflammation be
trifling,  a weak  solution  of hydrargyrus muriatus in
lime-water :
R. Hydrargyri muriati gr. x.   Take Muriate of mercury gr. X.
   Aquae calcis f^ss.            Lime water ffjss.
   The solution of ammonia muriata, page 67.
   A mixture of fresh bile with saponaceous liniment.
   Plasters of soap, ammoniacuni, and mercury.
   Cold  poultices,  with  salt-water, or sea-water,  and
bread.
   Hemlock, bruised and applied to the part.
   Mercurial ointment* 
8-1
ANEURISM.
  The  quercus marinus,  or sea tang, bruised and
formed into a cataplasm.
  Dr.  Underwood recommends an epithem composed
of flour, honey, the yolk of an egg, and yeast.
  All  Avarm  and emollient app v ations  should be
avoided, until the attempts at resolution have failed,
and the fluctuation of a fluid becomes distinctly per-
ceptible ; Avhen the  process of suppuration is  to be
expedited by these means.
  Most surgeons agree in the propriety of permitting
the bubo to rupture after the ineffectual use  of some
of the above remedies ;  Avhilst others strongly recom-
mend the evacuation of the matter through a  small
Valvular opening, and a consequent application of the
lotio aluminis :
R. Aluminis 5ss.            Take Super sulphate ofalumen
                                   and potash 5ss.
  Aquae distillatae j^j.         Distilled water j^ji.
  The earlier the incision is made the better, as it pre-
vents the deformity which so often succeeds SAvellings
of this nature, when allowed to  ulcerate through the
integuments.
                 OF ANEURISM.
  Aneurism is a tumor formed by the yielding of the
coats of an artery ; contaiiiing blood, and having a
pulsatory motion.—It  may occur in  any part  of the
arterial system ; but the parts where it is  most fre-
quently met with are  the ham, the  thigh, about half
way betAveen the bifurcation of the aorta and the renal
vessels, ^t the curvature of the same vessel in the chest,
in the neck, sometimes in the arm, and in the groin. 
ANEURISM
-S~i
                     SYMPTOMS.
  The popliteal aneurism, being that Avhich occurs most
frequently, may be taken as an example.—A small tu-
mor is  first perceived, firm, and little affected by the
pulsation of the  artery;—it is attended Avith little or
no pain, and is disregarded by the patient.—It increases'
in size, becomes  softer to the feel, and has noAV a very
strong pulsatory motion ;  and upon pressure entirely
disappears, but returns again as  soon as the cause of
compression is removed.—Lancinating pains arise, and
there is  an unaccountable  sensation of heaviness, pain,
and numbness, through all the limb, often accompanied
with severe cramps.—As the swelling enlarges, it ac-
quires great hardness, and the throbbing, before violent
and alarming, is noAV  diminished ; neither is the blood
capable of being removed by pressure, from its situation.
—Tin- leg becomes cedematotts, heavy, cold, and pulse-
less.—At  length  the integuments,  in some cases,
acquire a livid hue, the skin becomes thinner from day
to day.  it cracks and scabs, and blood issues through
the crevices ;  but the first  haemorrhage seldom proves
fatal : the patient immediately faints, and a coagulum is
formed and closes the orifice ; ulceration, hoAvever, soon
extends, and the patient at  last expires after a large ef-
fusion, tliough often not until the lapse of many months,
or even years, from the first accession of the disease.
                      CAUSES.
   Predisposing.—A constitutional predisposition ; ap-
pearing mostly about the middle period of life.
   Exciting.__Debility, hoAvever induced ;—accidental
injury, of whatever kind ;—the removal or destruction
of neighbouring parts ; by which the artery is deprived
of its usual support.
                          I 
86                  ANEURISM.
                     DIAGNOSIS.
  The violent pulsation of the tumor, together with its
being situated over an artery, will in  general be sure
characteristics of the disease.—It may be distinguished
from  tumors  of another nature, Avhich may happen to
obtain a pulsatory motion from their contiguity to a
large artery,  by  compressing  the  vessel  above the
sAvelling ; when, if the latter be aneurismal, it aa ill be
very considerably diminished, or will totally disappear.
                    TREATMENT.
  In  the early stages, and while the blood can be yet
pressed entirely out of the sac, compression by means
of a bandage, composed  of soft and someAvhat elastic
materials, and properly adapted to  the part.— If this
prove of no effect, the operation will become necessary.
          THE OPERATIONS FOR ANEURISM.
  For aneurism in general.—The necessary  prepara-
tions being made,  and the patient placed in a commo-
dious position, the first  step ought to be to obtain a
perfect command  over the circulation of the inferior
part of the member, by means of the tourniquet.—After
this has been adjusted, the operator is, with  a  common
scalpel, to make an incision through the skin and cel-
lular  substance, along the Avhole course of  the tumor.
On the latter being thus exposed to view, a small open-
ing is to be made into it Avith a lancet, of sufficient size
for the admission of the finger ; Avhen the Avhole cavity
is to be fairly laid open, from one extremity to the other,
by running a  blunt-pointed  bistouary  from  beloAv up-
wards, and afterwards from above  dowmvards. The
next step is to clear the cavity of its contents, by means
of the finger, assisted by a sponge.  This being done,
the tourniquet is  to be slackened in order to  discover 
ANEURISM.
87
the opening into the artery ;  when  this is  perceived,
after renewing the compression, a probe is to be intro-
duced so as to raise the vessel, or it may be taken hold
of by a pair of small forceps, and being thus exposed, it
is to be secured by a strong ligature passed around it,
by means of a blunt curved needle,  about half an inch
above the opening into the tumor.—The inferior por-
tion of the  artery is next to be tied in like manner,  and
the ends of the ligatures being brought over the edges
of the wound, the  latter is to be covered with soft lint,
and a pledget of emollient ointment.  A compress of
linen is then to be  applied over the whole, and  secured
by a roller  lightly passed around the  limb ;  after which
the patient is to be conveyed to bed, the limb supported
by a soft pilloAV, laid in a relaxed posture, and  covered
with Avarm flannel.—As  in all other  operations of a
similar nature,  it  will be prudent to allow the tourni-
quet to  remain upon  the limb, Avithout any degree of
pressure, till the danger of haemorrhage is over.
   It is recommended  by  surgeons of the present day,
in every case where such a mode of practice can be
admissible, to expose  the artery in a convenient situa.
tion above the tumor, and to secure it by ligature, in
the manner we shall  now direct for aneurism of the
popliteal artery.
   For popliteal aneurism.—Mr. Home  gives the fol-
loAving directions  for the improved  mode of operating
for popliteal aneurism, in  Transactions of  the Society
for the Improvement of Medicine and Surgery.
   An  incision  is  to be made, about  three inches in
length, on  the anterior and inner part of the thigh, at or
beloAV its  middle, in a direction obliquely across the
inner edge of the  sartorius muscle.—This, after being
exposed, is to be draAvn to the outside of the thigh, when 
88        FALSE OR DIFFUSED ANEURISM.

the fascia covering the femoral vessels, will immediately
be seen.—A slight incision is then to be made with ex-
treme caution through this fascia, and the artery, thus
laid  open to  vieAV, is to be separated from its  lateral
connexions Avith the knife, or by the help of a thin spat-
ula.   A double ligature is noAV to be passed behind it,
by means of an eyed probe properly curved, taking care
not to include the contiguous femoral vein, which is
situated on the inside, and  the nerve which is situated
to the outside of the artery.—The doubling of the lig-
ature is then to be divided, and the two thus formed are
to be separated, and securely tied at about the distance
of half  an  inch from each other.  After which the in-
termediate portion of artery is to be  cautiously divided,
and the  ends of the ligatures brought out of the wound,
the sides  of  which are to be kept in apposition by
straps of adhesive plaster, in order  to effect  an union
by the first intention.—The subsequent treatment  will
be, in every respect, similar to that above described.—
The ligatures may be removed with safety in about
tAvelve days.


  OF THE FALSE OR DIFFUSED ANEURISM.
  This  is  a tumor produced by an effusion of blood,
from a  Avounded or ruptured artery, into the cellular
membrane.
               DIAGNOSTIC SYMPTOMS.
  It appears  in the  form  of  a small  compressible
sAvelling,  haArng  a  strong  pulsatory  motion.—The
progress  of  its increase   varies in different cases ;
sometimes the enlargement proceeds  very rapidly, at
others it is months or years in arriving at any consid-
erable size,—It is much more diffused than the true 
THE VARICOSE ANEURISM.
89
aneurism, and  cannot, like that, be made to disappear
upon  pressure.—The  integuments:  sooner or  later,
lose their natural  appearance, ulcerate, and alloAv a
rupture  of the  internal sac ; though  sometimes not
until the tumor has attained an enormous size.   False
or diffused aneurisms acquire a livid  or marbled ap-
pearance, the veins become varicose, ulceration ensues,
and blood is evacuated.
                      CAUSF.S.
  An opening made into an  artery, by whatever cause ;
—rupture from external violence ;—puncture  in ve-
nesection ;—erosion from ulcers.
                    TREATMENT.
  In  the incipient  state, compression.—In the  more
advanced periods of the disease, the operation just de-
scribed.  Vide Aneurism.
  A case is related in the Medical and Physical  Jour-
nal, by Dr. Adams, of an aneurism of this nature  cured
by pressure upon the artery above the injured part.


       OF THE VARICOSE  ANEURISM.
  The varicose or  venous aneurism may be considered
as a  combination  of the tA\o former species ; being a
tumor consisting in an effusion of blood from an  artery
into an adjacent vein ;  arising  from a Avound  of the
former inflicted  through  the latter   vessel.—After
having attained a  certain size,  it frequently remains
stationary, Avithout alteration  or increase, for years ;
Sometimes for the remainder of life.
               DIAGNOSTIC SYMPTOMS.
  It is marked by a sort of tremulous motion  in the
                        12 
90
FEMd'RAL HERNIA.
vein, and by a peculiar hissing sound, occasioned by
the passage of blood through a small opening ;—by the
tumor being unaffected by compression of the vein be-
low ;—by its diminution or disappearance upon com-
pressing the artery ;—by a more  feeble  pulsation in
the  under part of that, than in the under part of the
member of the opposite side.
                   TREATMENT.
  Compression,  as recommended for  the incipient
state of true aneurism.—Should an operation become
unavoidable, it is to be performed in the manner al-
ready described.

                   OF HERNIA.
  Hernia is the protrusion of any viscus from its proper
cavity.—It has obtained various denominations, from
its  situation, as,  the inguinal, the scrotal, the femoral,
the umbilical or exomphalos, the ventral, the obturator,
the ischiatic,the labial, the cystic, and the diaphragmatic
hernia.—From its contents, as, the enterocele, contain-
ing intestine only;—the epiplocele,containing omentum
only ; and the entero-epiplocele, containing both omen-
tum and intestine.—From its different states, as, the re-
ducible, the irreducible, and the strangulated hernia.

            OF FEMORAL HERNIA*.
I. In the reducible state.
                    SYMPTOMS.
  Its first appearance is that of a small tumor, situated

  * The reader is referred to the elegant and practical Treatise
on Hernia by Mr. Astley Cooper, from which the following ac-
count of Inguinal Hernia is wholly taken. 
FEMORAL HERNIA.
91
about an inch and an half, on the outer side of the ab-
dominal ring in a line extending from the pubis  to the
anterior superior spinous process of the ilium. . (The
hernial  sac  first  emerges from the  abdomen  at'an
opening formed in a fascia given off upwards from
Poupart's ligament.  This apperture is bounded on its
upper part by the tendon of the  transversalis muscle ;
and is situated betAveen the spinous  process of the
ilium and pubis ;  about an inch and an half to the outer
and  upper side of the  abdominal  ring.   Thus  the
mouth of the  sac,  in  common cases of  hernia,  is
ahvays on the  outside  of  the epigastric artery.)—It
gradually protrudes obliquely  downwards,  and de-
scending  through the abdominal ring, proceeds into
the scrotum, and forms a distinct swelling, which often
increases to a large size.—It may be either enterocele,
distinguished by the regularity of its appearance, its
elasticity  and uniformity to the touch, and upon being
returned into the  abdomen by  its receding with a gug-
gling noise ;—epiplocele, marked by its want of elas-
ticity, by the  inequality  of  its appearance, by its being
cedematous  or slippery  to the  feel, and by its not re-
ceding Avith a gUgglingi noise ;—or  entero-epiplocele,
Avhen the tumor is more equal than in the  preceding
state ; yet it possesses the cedematous feel, and, upon
being returned, the intestine first  goes up  Avith the
sound above mentioned, the more  solid  omentum
slowly follows.
                      CAUSES.
   Predisposing.—Debility, however induced ; dimin-
ishing the resistance of muscles and their tendons ;—
malconformation of parts.
   Exciting.—-Accidental blows  ;—great muscular ex"- 
92
FEMORAL HERNIA.
ertion ;—pressure from obesity, or the Avearing of tight
clothes ;—pregnancy ;—any  forcible agitation of the
body ;  as the  riding of rough horses, or in rough car-
riages, jumping, 8cc. &c.
                     DIAGNOSIS.
  The distinctive marks Avhich characterize a hernial
tumor are—distention upon coughing ;—the capability,
Avhen in a horizontal  posture, of being returned into
the abdomen ;—its again appearing upon resuming an
erect position ;—its first appearing in the groin, and
thence descending into the scrotum.
  From hydrocele.—By the latter beginning to form at
the lower part  of the scrotum, and thence gradually
ascending to the abdominal ring;—by its fluctuation
and transparency in the one ;  by the absence of these
symptoms in the other disease.—In hernia the  testicle
may generally be distinctly felt below the tumor ; in
hydrocele it is involved in the substance of the swelling,
and  can with difficulty  be  felt.—Hydrocele until  it
has  increased to a great size, is  not dilated upon
coughing.
  From enlarged testicle.—Vide^ Diseases of the Tes-
ticle.  JrEL>rri44*s o/£*«**%*-v&&*'   ~t3^"'«
  From hematocele.—Vide Hematocele.  <Z-Zfi «
  From varicocele.—.All the marks of reducible hernia
are present in varicocele.—.The tAvo  diseases may thus
be distinguished : When in a recumbent position, after
having returned the tumor into  the abdomen, firm
pressure is to be made upon the abdominal ring, and
carefully preserved  Avhile the patient rises to an erect
position, when,  if the tumor be hernia, it cannot reap-
pear until the  compressing cause is removed.—On the
contrary, if it be  varicocele, it soon returns with in- 
FEMORAL HERNIA.
93
creased size.—The tumor in the latter disease has also
an irregular ropy feel, Avhich is not observed in hernia.
                   TREATMENT.
  After a reduction of the tumor (Avhich in this state
can readily be effected by the patient himself), the uni-
versal mode of preventing its return, is the application
of a truss.—This is, usually formed of steel properly
coArered Avith soft leather, and so tempered as Avith fa-
cility to adapt itself to the lower part of the body, Avhich
it embraces like a belt.—At its extremity is a pad of a
conical form, which, when applied to the mouth of the
hernial sac, occasions, by constant pressure, an adhesion
to take place between its sides, in consequence of which
the patient is cured—In common hernia, the proper
spot for the application of the pad is midAvay between
the symphysis pubis and spine of the ilium.—In very
large hernia, it should be brought nearer to the abdom-
inal ring, but never completely upon the pubis.—It
should be worn for two years, and during that time left
off on no occasion.
n.  Of the irreducible state.
  This is a state of hernia in which the tumor is inca-
pable of being returned into the abdomen by outAvard
pressure.  It often in these cases increases to an enor-
mous size.
        CAUSES OF THE IRREDUCIBLE STATE.
   1. The protruded tumor being long suffered to re-
main doAvn, after having attained a considerable bulk ;
in Avhich case the  abdomen accommodates itself to its
contents, and is no longer able to receive the protruded,
and noAV extraneous parts.
  2. Membranous bands, the  consequence of inflam- 
94
FEMORAL HERNIA.
mation, forming across the tumor, and thus entangling
its contents.
  3. An adhesion of the protruded parts  to  the sides
of the sac.
  4. Contractions of the sac at its middle.
  5. A schirrous state of the omentum.
                   TREATMENT.
  Support is to be afforded to the tumor, by means of
an apparatus called a bag-truss.—This  consists in a
simple bag, made of calico, connected by attached tapes
to a girdle of the  same materials, made to encircle the
hips.   A  steady pressure is thus made upon the part,
which not only prevents a further protrusion, but has
in some instances produced an absorption of the adipose
substance, and ultimately a reduction of  the tumor.—
In some cases supposed to be irreducible, the applica-
tion of ice—Aide Treatment of Strangulated Hernia—
by contracting the scrotum, has caused a return of the
protruded parts.
In the strangulated state.
  In  the  strangulated state of hernia there is such a
compression of  the blood-vessels, as to excite inflam-
mation, and interrupt the passage of the faeces through
the descended portion.
                     SYMPTOMS.
  Sense of stricture at the upper part of the abdomen,
or at the navel;—frequent eructations ;—vomiting of a
bilious, and  sometimes of a feculent matter ;—obsti-
nate constipation ;—quick, hard pulse.—The tumor is
red, painful, and  cedematous ;—.the abdomen becomes
sore, and painful to the touch ;—a profuse perspiration
breaks out over the body ;—the pulse becomes small
 and thready ;—troublesome hiccup ;—remarkable ex- 
FEMORAL HERNIA.               95
pression of anxiety in the countenance.—These symp-
toms often mi fier a remission, but return again with
increased violence.
   If reduction be not speedily effected, a mortification
of the intestine takes place, when  the patient, after
suffering intolerable  pain, becomes suddenly easy ;—
the tumor assumes a  purple,  or leaden  colour, and
from being tense and elastic, becomes soft and doughy,
and has  an emphysematous feel;—the abdomen be-
comes more tense, the hiccup more seA'ere ;—the body
is covered Avith a cold clammy SAveat,—the eyes  have
a  glassy appearance,—the  pulse  is irregular, though
softer and fuller ;—the patient is tranquil and sensible
to the last, and often expires Avith the delusive hope of
recovery.
            CAUSES OF STRANGULATION.
   The exciting cause—may be any of the causes Avhich
originally produced the tumor.  Vide Causes of Irre-
ducible Hernia.
   The proximate—a stricture caused by the unyielding
nature of the parts, operating like a tight cord upon the
protruded intestine.  Vide the Operation for Strangu-
lated Hernia.
                    TREATMENT.
   The first object will  be to endeavour to return the
displaced parts, by the manual operation called taxis.
For this purpose the patient (previously  directed to
void his urine) is  to be laid upon his back; the pelvis
elevated  by a pillow above the leA'el  of the abdomen,
the thighs raised to a right angle with the body, and
brought so closely together, as  only to admit the sur-
geon's hand between them.  By  this  means all the
muscles  and apertures of the abdomen will be relaxed. 
96
FEMORAL HERNIA.
 The surgeon, situated to the right side of the patient,
 should now embrace the lower part of the tumor Avith
 his right hand, and the upper part,  where it enters the
 abdomen, with the finger and thumb of his left.  The
 compression of the former should be firm and constant;
 that of the latter  moveable, inclining it alternately to
 each side, and endeavouring to insinuate a small por-
 tion at a time of the displaced parts into the abdomen.
   Should  the above operation, after a quarter of an
 hour's  perseverance, prove  unsuccessful, it must be
 assisted by other  means:—by  copious  bleeding;—-by
 the warm bath,  continued until  faintness  is induced,
 Avhen the taxis should be immediately repeated; by a
 clyster of tobacco—one dram of tobacco to  be infused
 in tAvelve ounces of water for ten minutes—of this on-
 ly half is at first to be administered, the remainder at
 the expiration of half an hour  if necessary ;—by the
 application of cold—pounded ice  contained in a blad-
 der, or a solution of ammonia muriata Avith vinegar, or
 of common  salt  and sal ammoniac.  Opium may be
 given to allay the violence of the vomiting; purging is,
 in general, prejudicial; it is only admissible where the
 symptoms are slight,  and  where no  vomiting is pre-
 sent.   Fomentations are inferior to cold applications ;
 yet where the tumor is extremely tense, and the scro-
 tum much inflamed, together with leeches, they have
 been successfully employed.
  If these means fail, the only resource is in an opera-
tion for the liberation of the confined parts.
                  THE OPERATION.
  The  patient being commodiously  laid, the hair re-
 moved from the parts, and other necessaay preparations
 made, the tumor is to be firmly grasped Avith the left 
FEMORAL HERNIA,
97
hand, while an incision is made (if it be not extremely
large) through the integuments, along its whole extent.
By this the skin and cellular substance will be divided,
and a thin fascia exposed which is given off by the ex-
ternal oblique muscle.—Through the middle  of this a
small opening is then to be made, for the introduction of
a director, by the assistance of which it is to be dilated
upAvard to within one inch of the abdominial ring, and
in a similar manner downwards  to  the bottom of the
tumor.—The second covering of the sac, or the crem-
aster muscle, next comes in sight, and this being divid-
ed precisely as  the preceding fascia, the sac  itself is
exposed to view.—Tie anterior and inferior portion of
the sac is now to be pinched  up between the fingers,
and being thereby separated from its contents, a  small
hole  is  to be  made into it, in  an horizontal direction ;
after  which it is to be  carefully dilated in the same
manner as the preceding tunics.
   The next step is to remove  the stricture;—in  order
to ascertain the seat of Avnich, the finger is to be insinu-
ated between the intestine and the sac, and carried up
to the mouth of the tumor.—-It will be found in one ot
these situations ; either at the( opening  into the abdo-
men,  an inch and a half to the  outer and upper side of
the abdominal ring,—at tne external or abdominal ring,
—or in the sac itself, rendered preternaturally thick by
the previous pressure of a tiuss, or constricting the
contained parts by means of a  septum w ich has  been
formed across it in consequence of inflammation.—In
order to dilate the strictured part, the finger must now
be ma.le the  guide to a  blunt-poiuted bistoury, which
is to be car. fully passed up on the outside of the sac, if
the stricture be in either  of  the two first-mentioned
                        K 
98
FEMORAL 11LRNIA.
situations,  but on the inside if in the last ; and having
reached the desired part, an incision is to be made
through the tendon,  or  other resisting substance, in a
line  directly  u/nvardu, of sufficient  extent to admit of
the return  of the  protruded parts.
  Having thus removed the stricture, the state of the
lacerated parts is to be carefully examined.—When the
intestine remains sound, it is  sound  to the touch ; the
brown colour, invariably acquired under strangulation,
soon lessens,  or  entirely disappears ; and  the blood,
when pressed  from  a vein, speedily returns. If thus
free from injury, it  should be immediately returned
into the  abdomen, carefully  dissecting any adhesions
that may have formed betAveen it and the sac.  If, on
the contrary, the injury it has sustained by strangulation
has been so great as to have induced mortification, it
Avill be found of a deep broAvn  or  chocolate colour,
covered with a layer ofbroAvn coagulable lymph, fetid,
and interspersed  Avith purple or leaden-coloured spots,
which readily break doAvn under the  impression of the
finger.  In such cases  the folloAving  treatment is re-
commended :  If a small portion only of the cylinder be
diseased, a  ligature is to be passed through the attached
mesentery, at right angles with the  intestine, and then
through  the  mouth  of the hernial  sac, when by this
means the  intestine becomes confined to the aperture,
adhesions form, and an artificial anus  is produced.  The
opening has, however, in some instances, after a time,
closed ;  and  the faeces  have resumed their natural
course :  but Avhen the Avhole cylinder is mortified, tie
diseased part should be cut aAvay ; the divided ends
brought  together, and  united by means of four liga-
tures, inserted around the intestine.   Vide  Wounds of
the Intestines. 
HERNIA CONGENITA.
99
  The omentum is iioav to be inspected.  This, even
in a diseased state, retains its natural appearance ;  the
presence of mortification is ascertained by its fetid
smell, and upon cutting into it, by the blood, instead of
flowing from the vessels, being found coagulated.—If
in a healthy state it may, if not very large, be returned
into the abdomen ;—if it be diseased, or if its bulk be
very considerable, it is directed to be removed Avith a
knife, and the vessels  secured by very  fine ligatures,
which should be suffered to hang from the edges of the
wound.
  The external wound should be closed by suture, the
patient laid in bed, and rest procured by opiates.
             HERNIA CONGENITA.
  Hernia congenita is a protrusion of some of the
contents of the abdomen into the cavity of the tunica
vaginalis of the testis ; owing to the want of the cus-
tomary adhesion between its sides, after the descent
of the testicle in early life.—It is more frequently seen
in children, soon after birth.—It is distinguished from
bubonocele by  the testicle  not being distinctly felt at
the bottom of the tumor ;—and from hydrocele of the
spermatic cord, for which it is often mistaken, by pres-
sure made upon the abdominal ring, after the swelling
has receded in the recumbent posture, preventing its
return, upon rising to the erect position.  Vide Diag-
nosis of Bubonocele.
  In hernia congenita, previous to the application of a
truss, it will be expedient carefully to ascertain, by ex-
amination, if the testis have  already descended into the
scrotum.—Should this not be the case, a truss ought. 
100        FEMORAL OR CRURAL HERNIA.

never to be applied, as it would entirely  prevent the
descent of the testicle, Avhich yet remains in the ab-
domen.


       FEMORAL OR CRURAL HERNIA.
   The  seat of femoral hernia is the upper and fore
part of the thigh, the protruded bowels passing out at
the  same opening through which the large blood-ves-
sels are transmitted to the  thigh  ; and consequently
under the crural arch, or Fallopius's ligament.
   T,e tumor, though  sometimes situated immediately
over the femoral vessels,is very generally on their inner
side ;  for in the internal and  lateral parts of the  sheath
in Avhich  tn:-y are enclosed, and close to the branch of
the  os pubis, " precisely Avhere the insertion  of the
dupiicature  of the  arch ends (vide New  Method of
of rating  for Femoral Hernia,  translated from the
 Spa.-.-i-Ji of Don Antonio de Gimbernat),  and  on the
inside of the great secondary iliac vein, there is left a
foramen sufficiently dis inct and almost round, at Avhich
many lymphatics enter.— A lymphatic gland is some-
times fitted into  this foramen, and the parts which form
 the crural hernia ahvays pass through it;  consequently
 Ave  may properly call it the crural ring."—" A single
 gland, placed in this ring, Avould prevent the issue of
 the parts contained in the abdomen ; but if a  portion
 of the intestine should slide behind, so as to get out of
 the cavity, it would be very difficult to distinguish the
 hernia at first."
                      DIAGNOSIS.
   It  is distinguished from bubonocele  by the  tumor
 being seated deeper and more laterally  ; and the ring
 of the abdominal muscles, which lies entirely above the 
           FEMORAL  OR ©RURAL  HERNIA.        161

tumor, in  femoral hernia, completely surrounding the
parts in the inguinal kind ;—from bubo, in the reduci-
ble state,  by the capability of reduction;  in the stran-
gulated state,  by the symptoms of strangulation;—
from psoas abscess, by the fluctuation of the tumor in
the latter  disease ; and by the  preceding long-continu-
ed and deep-seated pain in the loins.
                   TREATMENT.
  The treatment laid down for inguinal hernia will, for
the most  part, be applicable to the species now under
consideration.
  In the  manual attempts at reduction, the tumor
should be pressed in a direction upwards, and inwards
towards the abdomen; and  at the  same  time, down-
wards toAvards the pubis.
  The operation for dividing the part which occasions
strangulation, is directed by Gimbernat to be perform-
ed as foliows:
  After the preparatory steps have been taken, and the
hernial sac divided, a  canulated or grooved sound is to
be introduced along the  internal side of the  intestine,
until it enter the crural ring, Avhen it is to be held with
the left hand, firmly resting on the branch of the pubis,
so that its back shall be turned towards the intestine,
and its canal towards the symphysis pubis.—A bistoury?
with a narrow blade and blunt  end, is  then to be pas-
sed  along the  groove, until  it enter the ring; after
which both  instruments  are to be  cautiously carried
inwards, along the branch, to the body of the pubis,
draAving them  out at the  same time.—The  internal
edge of the  crural arch being thus divided,  the parts
will be reduced with  the greatest ease; and the danger
of wounding the Fallopian ligament, and the  spcrmat-
                  K2 
102
UMBILICAL HERNIA.
ic and gastric vessels, Avill  by this mode of operating
be avoided.
  Under certain circumstances, hoAvever,  the  above
means may be inadequate to the liberation of the dis-
placed parts; in Avhich case the following seems the
preferable mode of proceeding.  Vide Borrett in Med-
ical and Physical Journal.
  " Make a small incision between the fibres of the ex-
ternal oblique muscle, about half an  inch  above the
ligament; and  a director being passed carefully, and
immediately under the  ligament, and over  the  artery
(which adheres to the ligament), cut  into the groove
of the director."—If, when this is done, the stricture
be found at  the  mouth of  the sac, it must be divided
inwards to the pubes,  inclining Pott's knife a little ob-
liquely downAvards.

                 EXOMPHALOS.
  In the exomphalos, or umbilical hernia, some  of the
viscera of the abdomen, more frequently the omentum,
pass out at the umbilicus ;  and,  as in the other species
of hernia, are included in a sac formed by the perito-
naeum.—It occurs  most frequently in  infancy, soon
after birth:—in the adult state  corpulent  people are
more frequently its subjects ; and pregnant women are
particularly liable to  it, on account  of the enlarged
size of the uterus.
                    TREATMENT.
  The early and proper application of a bandage, or
strong slips of adhesive plaster, will often be sufficient
to effect a cure;—should they not, recourse  must be
had to the elastic truss, invented for this purpose.__If
the operation become  requisite,  an incision should be 
INJURIES  TO THE BRAIN.
103
made in the most depending part of the tumor; and
the sac being exposed, the finger should be introduced
under its contents, and made a guide to Pott's bistoury,
with which the tendon forming the stricture is to be
dilated: thus will  be  obviated the danger of exciting
inflammation, by too free an exposure of the cavity.
  The other species of Hernia, viz. the ventral, the ob-
turator,  the ischiatic, the labial, the cystic, and  the di-
aphragmatic, are extremely rare in their occurrence__
Their treatment may be deduced from what has been
already said of Inguinal and Femoral Hernia.
    OF INJURIES TO THE BRAIN FROM
            EXTERNAL VIOLENCE.
  All injuries to the brain from external violence have
been divided into two distinct states:—1. The state of
contusion;—2. The state of compression.  Abernethy's
Surgical and Physical Essays,  Part III.
 OF THE GENERAL  EFFECTS  OR  SYMPTOMS OF  IN-
               JURY TO THE  BRAIN.
  Drowsiness;—giddiness;—dimness of sight;—.par-
tial or complete loss of sense ;—dilatation of the pupil;
—irregular oppressed pulse ;—snoring  or apoplectic
stertor in  breathing;—nausea  and vomiting.   If the
injury have been severe, a discharge of blood from the
eyes, nose, and ears ;—involuntary  discharges of faeces
and urine ;—consequent paralysis.


     OF CONCUSSION OF THE  BRAIN.
                    SYMPTOMS.
  The effect of concussion of the  brain,  Avhen slight,
is  what has commonly  been called stunnuig;  which 
104        CONCUSSION  OF THE BRAIN.
consists in—giddiness;—noise  in the  ears;—loss  of
memory;—stupefaction.   These are of a temporary
nature only, and soon leave the subject of the accident
in the entire  possession of his intellects.
   When more severe, there is an instant and total loss
of sense and  voluntary motion,—sickness,—the breath-
ing is natural yet sloAver than  usual, unaccompanied
with apoplectic stertor, and the patient appears as in a
sound sleep.   The pulse is sometimes slow, and irreg-
ular or intermitting ; at others Aveak, soft,  and  equal;
—the pupil of the eye is immovable;—the extremities
are cold; but the  muscles  of the  limbs retain their
natural state  of tone, and are not relaxed as in the state
of compression.  These symptoms continue for a long-
er or shorter space of time ; in  some  instances for a
few hours only, in others for weeks  and even months ;
and either terminate in inflammation of the brain ;  or
the respiration gradually becomes more free, a genial
warmth is diffused over the body, the patient becomes
sensible to impressions, and sloAvly  recovers.—Hem-
iplegia, strabismus, and fatuity, are hoAvever not unfre-
quent consequences.
                    TREATMENT.
  In accidents of this nature, the use of diffusive stim-
uli, and of powerful cordials, has been  usually recom-
mended ; as, wine,—volatile alkali,—ardent spirits,—
blisters, and sinapisms to the feet, Sec.
  Mr. Abernethy disapproves  of this mode of treat-
ment,  and advises bleeding from the arm, or from the
jugular vein  or temporal artery ;—drastic purgatives ;
—antimonials ;—the saline medicine Avith  antimonial
wine, 
COMPRESSION OF THE  BRAIN
105
  Mr. Bromfield recommends  the  union of antimony
Avith opium.
R. rinctui-x opii Jij.          Take tincture of opium 5'j-
  Vini autimonii tartarisati Jvj.   Wine of J'artarized Antimony
                                           3v'h
M cujus capiat guttas x. sexta  Mix. Take ten drops every six
         qnaque hora                      hours.
   Blisters to the scalp have been also successful in de-
termining the fluids to the  external part.
   An incision made in the injured  part, and an emolli-
ent poultice  applied over  it, is a  mode  of treatment
employed with success on the  continent.
   An operation will, in common .cases,  only serve to
aggrevate the affection ; but where concussion is com-
bined with fracture, after the above plan has been fairly
practised Avithout affording success,  recourse may be
had to the use of the trephine, as  a possible mode of
 relief.

     OF  COMPRESSION OF THE BRAIN.
             CHARACTERISTIC  SYMPTOMS.
   Loss of sense and voluntary  motion, coming on grad-
 ually, not instantly, as in the preceding state of injury ;—
 the stertorous breathing, which marks the  presence of
 apoplexy ;—the pulse extremely slow, oppressed, and
 irregular, but less intermitting than in concussion ;—
 the muscles of the limbs relaxed ;—the pupils of the
  eyes much  dilated.
                        causes.  •
    Depression  of bone  with  fracture;—fracture with
  extravasation of blood;—extravasation of blood with-
  out fracture ;—an effusion of matter succeeding in-
  flammation. 
106        COMPRESSION  OF THE BRAIN.       _

                   TREATMENT.
  The first object is to ascertain the situation, nature,
and extent of the injury.   When this cannot be done
by a superficial examination, the Avhole head should be
shaved; after which, upon inspection,  the part Avhich
has sustained the injury  Avill often be detected by an
inflammatory spot or  small tumor,—or by the uneasi-
ness expressed by the patient upon  pressure,—.or by
his frequently lifting his hand, and applying it to a par-
ticular part of the head.
  When at length this has been discovered, an incision
must be made through the  integuments  down to the
bone.  The further treatment  will depend  upon the
state in which the parts are  found.
  If there be fracture or  depression  of bone, the op-
eration should instantly be performed.—If there be no
fracture  nor depression,  after  a careful  examination
has ascertained no other seat of injury to  exist, it may
be concluded that the symptoms arise from  an extra-
vasation of  blood; the  almost certain  criterion  of
which is,  no  blood issuing from the bone  upon the re-
moval of  the pericranium (Mr. Abernethy,  Surgical
Essays) ;—or the bone having lost its natural appear-
ance, and  become of a whitish or dusky yellow hue.—
In such case the  antiphlogistic  treatment  recommend-
ed for concussion may first  be practised;  and if,  after
a fair trial,   the  symptoms  still  continue,  recourse
should be had to  the operation Avithout further delay.
                 THE OPERATION.
   The first step to be taken (the incision being previ-
ously made), is to remove as much of the  pericranium
as will be sufficient to admit  the  application of the
trephine.  Tins is performed by means of an instru-
ment called the engine.   Tne trephine, with its annex- 
COMPRESSION OF THE BRAIN.        107
ed perforator is then to be applied, including Avithin its
circle a larger portion of the depressed than  of the
sound bone, and, after having made a few turns to
secure it in its situation, the central pin or perforator*
should be  removed, as no longer useful, and the op-
erator is to proceed, with great caution, to saw through
the bone ;  using a semi-rotary motion with the  instru-
ment backwards  and forwards,  occasionally brushing
the accumulated particles of bone from its teeth, and
often, with a probe, examining  the sulcus which  has
been made, to ascertain if any part be already perfo-
rated.   As soon as this is the case, redoubled caution
must be used, and the instrument should be made to
bear upon the imperforated parts, until  the bone be-
comes sufficiently loose to be removed with the forceps
or elevator.
  The  parts beneath the  cranium being now exposed
to vieAv, if the replacement of a depressed piece of bone
be the object  of  the operation, it is  to be effected by
means of an instrument called the elevator.  This acts
as a lever, the fulcrum to which  should be either the
sound  portion  of bone, or  the  finger  laid over it.—
Should  an accumulation of blood  have given rise to the
symptoms, the fluid Avill  now, if situated between the
dura mater and the bone, have a free exit; if it  be col-
lected beneath the dura mater, that membrane  will be
found tense, dark-coloured, or even livid.  In this case
an opening becomes necessary.   This should be per-
formed  by making gentle  scratches or incisions with a
scalpel, until a director can be introduced; upon Avhich
  * The instrument is here described in us improved state, as
now actually constructed. 
 108        FUNGUS AND HERNIA CEREBRI.

the membrane should be sufficiently divided to afford
an outlet to the fluid.
  If, after the operation, any points of bone remain at-
tached to the sides of the orifice, these should be care-
fully separated by the forceps or the elevator.
  For the treatment of the wound, the folloAving rules
are necessary : If the operation has been performed for
fracture  or depression, unless pieces of bone are ex-
pected still to come away, union should be effected by
the first intention ;—if for  the evacuation of blood or
matter (see Infiammation of the Brain), the sore is to
be dressed in the lightest  and easiest manner, and a
speedy suppuration invited by emollient cataplasms.
  Certain  objectionable parts of the head are usually
pointed out, and considered as improper to become the
subjects   of the above  operation.— These  arc—the
course of  longitudinal sinuses,—the  crucial ricige of
the occipital bone,—the anterior and  inferior angle of
each parietal bone,—and the part immediately covering
the frontal sinuses ; but in cases of extreme danger
these rules should be disregarded.—Perhaps there is
no part really objectionable but the last mentioned.
  A saw has b en invented by Mr. Hey (see his Obser-
vations in Surgiry), with which protruding points may-
be removed, so as to admit  the elevator, with the loss
of a very  small  portion of the injured bone.—This,
wherever it may be admissible,  should be substituted
for the trephine.
  Of the Consequences of Injuries to the Brain.
  OF FUNGUS AND HERNIA CEREBRI.
The fuii^us is simply an exuberant  protrusion  of 
           FUNGUS AND HERNIA CEREBRI.        109

granulations  beyond the level of the cranium, arising
usually from the surface of the dura mater, or from the
cut edges of the bone granulating luxuriantly.
  Hernia cerebri is a tumor formed by the pressure of
blcod, which has been extravasated into the substance
of the brain, owing to a diseased state of its vessels in-
duced by one of the foregoing causes.—The effused
fluid, if the  skull were entire, would in all probability,
induce apoplexy ;  but when a deficiency of bone exists,
so  as  to  allow it to expand, it presses the surface of
the brain and its meninges, through the vacant space,
and there forms a tumor, which continues to  increase
in size, until the superficial stratum of brain becomes
so distended as to give way ;  when blood oozes  out,
and forms a coagulum.
                    TREATMENT.
  Of the fungus.—Moderate pressure ;—the  constant
application  of dry lint;—sprinkling  the  excrescence.
Avith pulverized myrrh, or lapis calaminaris.
  Of the hernia,—All  pressure should  be  carefully
avoided,  and nothing in general need be done but daily
lo apply  simple dressings ;- Avhen the coagulum  will
soon drop off, and the tumor Avaste aAvay.
  Mr. Hill  has treated several cases of tumor of this
nature, Avhich have obtained a large size, by occasional
paring.
  Ligatures  and styptics are dangerous, and should be
avoided.
  Should the haemorrhage be so great as to  threaten
danger, the coagulum should be  removed, the bleeding
vessel exposed, and  some diluted vegetable astringent,
as infusion of galls, may probably be applied with suc-
cess to stop the bleeding.  Mr.  Abernethy.
                        L 
110        INFLAMMATION OF THE BRAfN.

    OF INFLAMMATION OF THE BRAIN,
  The time of the accession of inflammation of the
brain, Avhen the consequence of external violence, is
generally about the seventh or tenth clay ; sometimes,
however, not  until  after the expiration of several
weeks after the injury has been received,
                     SYMPTOMS.
  Giddiness, nausea, and vomiting, or a severe rigor
after  some  previous  pain ;—the skin becomes hot ;—
the pulse hard and rapid, giving the sensation  of a
small vibrating cord;—the face is flushed ;<—the tunica
conjunctiva distended with blood, and there is morbid
sensibility to the slightest impressions ;—the pupil is
contracted ;—the countenance Avild ;—raving delirium.
  Upon examining the injured part, it is Usually found
cedematous and painful to the touch ;—an erysipelatous
inflammation sometimes occupies the whole scalp, and
if there be  a Avound, this assumes  a broAvn colour, is
covered with a transparent lymph, and attended with a
pulsating pain, shooting to the extremities.—The pe-
ricranium is often found detached, and the bone Avhite,
or covered Avith a bloody ichor.
  The patient is usually either destroyed during this,
the inflammatory stage  ; or the former symptoms in a
great measure disappear, and those of suppuration suc-
ceed ;—severe rigors come on ;—stupor or coma takes
the place of constant vigilance, and is folloAved by hemi-
plegia ;—the  pupil becomes dilated ;—the urine and
faeces are passed involuntarily ;—subsultus tendinum,
convulsions, and  death,  are the infallible consequencesj
u;f speedy relief be not afforded. 
INFLAMMATION OF THE EYE.
Ill
                   TREATMENT.
           r i. In the  first  stage, to endeavour to
                 cure a resolution of the inflamma-
r  ,-       J     t5°n-
Indications.<      . ri               ,    ^ .     .
           j n. Alter suppuration has taken place,
                 to give a free vent to the collected
           t^    matter.
                        i.
  By copious venesection, and the antiphlogistic treat-
ment, recommended in medical works for phrenitis ;—
by the topical use  of emollient poultices and  of  fo-
mentations.
                        n.
  By the operation ; performed as above described,
page 106.
  After the removal of the bone, if the matter be be-
tween that and the dura mater, it immediately finds an
exit;—if it be  collected under  the dura mater, ascer-
tained by the  tension of that membrane, and by the ev-
ident fluctuation of a fluid beneath, a valvular opening
should be cautiously made, and of  sufficient extent to
alloAV of the evacuation of the matter.
OF THE DISEASES OF THE EYE.
OF OPHTHALMIA, OR INFLAMMATION OF
                   THE EYE.
Species.
           Ophthalmia membranarum.
           Ophthalmia tarsi
                  SYMPTOMS.
Of  'he  ophthalmia membranarum,—Piercing pair, 
 H2         INFLAMMATION OF THE EYE.

 confined to a point, as if occasioned by the presence of
 extraneous matter ;—great heat and  redness ;—the
 parts sAvell, and the Aessels of the eye not only increase
 in size and become turgid, but appear more numerous
 than  in the natural state.—Great pain upon the least
 motion of the eyeball ;—morbid sensibility to light ;—
 effusion of tears from the lachrymal gland, of an exco-
 riating quality—If the inflammation run high, a febrile
 disposition attends.
   After a longer or shorter continuance, these  appear-
 ances gradually abate, or entirely  cease ; but in some
 cases, although the patient  is left free from pain,  tu-
 mor, and symptomatic  fever, yet the  suffused  redness
 of the eye, and the external marks of inflammation, still
 remain, and  long continue to exist  after every other
 symptom has subsided.
   During  the continuance of the inflammation, small
 ulcers are often formed upon the cornea, and little col-
 lections of matter are sometimes deposited between its
 laminae,  Avhich frequently harden into Avhite  opake
 specks, and either partially  or totally obstruct the  en-
 trance of light.—.Matter is also sometimes effused into
 the chambers of  the eye, and either remains in a fluid
 state, or becomes inspissated, and  produces a  perma-
 nent  adhesion of the iris ;  or assumes the shape of
 a membrane dividing  the chamber  into  tAvo distinct
 cavities.
  In some cases, the disease  has been observed to  as-
 sume an intermittent form, renewing its attacks after
distinct intervals; or to have regular exacerbations at
a particular time of the day.
   The opthalmia  tarsi—consists in a chronic  inflam-
mation (frequently with ulceration)  of the scbacious
 glands, Avuicii are  situated in the tarsus or ei.^'es of the 
INFLAMMATION OF THE EYE.
US
eyelids.—It is often productive of much irritation, and,
when severe, occasions the destruction of the  cilia or
eyelashes.—It is universally esteemed  a  scrofulous
affection.
                      CAUSES.
  External injuries ;  such as blows, contusions, wounds
of the eyes.—Extraneous bodies of an irritating nature,
introduced under the  eyelids ;—exposure to bleak
winds,  and  cold ;—too  free a use of vinous and spirit-
uous liquors ;—suppression of accustomed dicharges ;
—long exposure to strong light ;—a fixed attention to
some  minute  object;—trichiasis, or inversion of the
eyelids.—It is symptomatic of certain other diseases,
as measles, small-pox, scurvy, scrofula, and syphilis.—
Contagion.
                   TREATMENT.
I. Of the ophthalmia membranarum.
              i. To remove causes that  continue to
                  operate.
              n. To reduce the inordinate action  of
                  the  vessels in the first stage of the
                  disease.
Indications.<      _,          „,  .  ^
              in.  To  restore their tone, to  increase
                  their action, and thereby remove tue
                  congestion of the  fluids, if the in-
                  flammation be protracted,  and as-
                  sume a chronic form.
                         i.
  Vide Causes of Ophthalmia for their removal.
  Foreign bodies entangled in the eye, may be removed
by a piece of wet lint attached to the ena  of a probe, or
by means of a stream of water injected by means of?
                        L2 
114         INFLAMMATION OF THE EYE.
syringe ;  w'ile the inside of the lid is turned outward,
by the  pressure of the fore-finger  and thumb of one
hand, applied to its lower edge.
  Particles of iron, forcibly projected, often stick in the
cornea: the most effectual means of removing them is
the application of the magnet.
  For the cure of tricniasis, when a cause of ophthal-
mia, see  Trichiasis.
                          n.
  By evacuations of blood from the temporal artery-—
from the  angular vein, Mr.  Ware,—by the application
of leeches to the temples,—or by scarifications of the
inflamed  vessel  ;—brisk  purgatives ;—small  blisters
applied to  the   temple ;—sedative, refrigerant, and
slightly astringent collyria.
R. Aquae lyihargyri acetati    Take solution of acetite of lead
                gutt. x.                      drops x.
   -----distillatae Jiv.         Distilled water ?iv.
Fiat collyrium.               Make a collyrium.
 COLLYRIUM LITHARGIRI   COLLYRIUM  OF  CAMPHORi
 ACETATI CAMPHORATUM    ATED ACETITE OF LEAD;
        Ph.  Chir.
R. Spiritus camphorati gutt.    Take camphorated sprits
                 xx.                        drops xx.
   Aquae lithargyri acetati      Solution  of acetite of lead
                gutt. x.                     drops x.
   -----distillatae 5iv.          Distilled water 5iv.
Fiat collyrium.               Make a Collyrium.
  A weak  solution of cerussa acetata ;  or a lotion of
aqua ammoniae acetatae with rose-water;—the cremor
lythargyri acetati Ph. Chir (vide Infiammation, page
4) ;—a cataplasm composed of the soft pulp of roasted
apples; 
INFLAMMATION OF THE EYE.
115
R. Cerussae acetatae gr. viij.      Take Acetite of Lead grs. viij.
  Aquae rosae distillatae 5viij.      Distilled Rose Water 5viij.
Fiat collyrium.                     make a collyrium.
R. Aqux ammoniae acetatae 5j.   Take Water of Acetite of Am-
                                       monia zi
  ------rose distillatx 2vij.      Distilled rose Water zvij.
Fiat collyrium.                     make a collyrium.
  Where the secretions are deficient, the cataplasm of
vitriolated soda is a good application.
 CATAPLASM NATRI VIT-    SULPHATE  OF SODA  POUL-
         RIOLATI                      TICE.
        Pharm  Chir.
R. Natri vitriolati rj.          Take Sulphate of Soda ?j.
  Aquae ferventis fjjSS.          Boiling Water 5vii j.
  Micae panis q. s.              Crumb of Bread q. s.
Fiat cataplasma.              Make a poultice.
  Should the pain and irritation be very severe and dis-
tressing,  a drop of the  vinous tincture of opium, con-
veyed twice daily into the eye, is an effectual  means of
relief.  Mr. Ware.
  The opiate collyrium is also an excellent remedy.
   COLLYRIUM OPIA1UM,        OPIATE COLLYRIUM.
        Pharm  Chir.
R. Opii in pulverem triti gr. j.     Take powdered Opium gr. i;
  Campliorae gr. ij.               Camphor grs. ij.
  Aquae ferventis 5iv.             Boiling Water ?iv.
The  opium  and camphire are to be rubbed  together,
  the hot water then added, and the liquor lastly strain-
  ed through a fine cloth.
  The poppy fomentation may also be used.
  Should the pain assume the intermittent form, hy-
drargyrus  muriatus with Peruvian bark, and opium
administered in large doses, a short time before the ex-
pected accession of the pain; are  recommended. 
116         INFLAMMATION OF THE EYE.
                         III.
  By astringents and stimulants.—Collyria of vitriol-
ated zinc,  of alum, of decoction  of bark Avith  lime-
water, of hydrargyrus muriatus.
  The alum and rose poultices.
               CATAPLASMA ALUMINIS.
A lump of alum briskly stirred with the whites of iavo
  eggs until they form a  coagulum; to be applied to
  the eye between tAvo pieces of thin rag.
    CATAPLASMA B.OSJE.         ROSE CATAPLASM.
R Conservae rbsae  nj.           Take conserve of Hoses £ij,
  Aluminis  Jss.                 Super Sulphate of Alumen
                                  and Potash Jss.
Fiat cataplasma.                Make a cataplasm.
  The internal  use of hydrargyrus  muriatus  as  an
alterative.
  The application of oleum terebinthinae  in an ex-
tremely diluted state.   See Memoirs  of the Medical
Society, vol. v.
  Or the vapour arising from the  spirit of turpentine.
See a Paper by Dr. Guthrie, in Duncan's Annals  of
Medicine.
  Errhines have been  successfully employed; as, the
pulvis asari  compositus,—or hydrargyrus vitriolatus,
Mr.  Ware.
R. Hydrargyri vitriolati gr. j.   Take Sulphate of Mercury gr. i.
  Pulverisglycyrrhizaegr. viij.    Liquorice Powder grs viij.
Misce optime pro pulvere    Make  an Errhine.
         errhino
  Electricity, in the form of  gentle sparks  from near
the eye.
   When weakness of the eye alone remains, frequent
ablution with cold water by means of an eye-cup.
 Of the  ophthalmia tarsi, 
GUTTA SERENA.
I IF.
  The internal use of hydrargyrus muriatus with cin-
chona ;—the  topical application of  the  unguentum
hydrargyri nitrati,—of zincum vitriolatum, made into
the form of an ointment.
  Should there be much pain, or great irritability, the
poppy fomentation, or the unguentum cicutae.
   UNGUENTUM CICUT/E.        CICUTA OINTMENT.
       Pharm  Chir.
R. Foliorum cicutae recentium,   Take Fresh cicuta leaves,
   Adipis suillae preparaiae, afi     Hag's lard, each -inv.

The cicuta is to be bruised in a marble mortar, after
  Avhich the lard is to be added, and the two ingredients
  incorporated by beating  : they are then to be gently
  moiled over the fire, and after being strained through
  a cloth, and the  fibrous  part of the  hemlock well
  pressed, the ointment to be stirred till quite cold,
    OF GUTTA SERENA, OR AMAUROSIS.
  The disease consists in a dimness of sight, whether
the object be  near or at a distance,  together with the
representation of flics, dust, Sec. floating before the eyes,
—No derangement of structure is evident to the sight;
—the pupil is usually dilated and immoveable,
                       CAUSL.S.
  Paralysis of the optic nerves, or pressure upon them
in tlieii course, either by encysted tumors  diseases of
contiguous bo les, a dilatation of the circulus arteriosus
surrounding the sella turcica  (Mr.  Ware),or a dilata-
tion ;;f the artery in the centre of the optic nerve ;—a
maiconformation of the optic nerves themselves, 
118
THE CATARACT
                   TREATMENT.
  The general and local use of stimuli;—blisters and
issues behind the ears, or at the back of the neck.
  Errhines. Vide Treatment of Ophthalmia, page 116*
  Electricity,  both sparks and gentle shocks.
  An infusion of dried capsicums in Avater, in the pro-
portion of tAvo grains to two drachms  of Avater ;  a few
drops to be dropped into the eye night and morning.
  When accompanied  with  a  contracted state of the
pupil, and  probably produced  by internal ophthalmy,
the internal use of hydrargyrus muriatus.  Mr. Ware.
  If the disease be supposed to arise from  compres-
sion,  the opposite of the above treatment  should be
practised : as bleeding, purging, Sec.
              OF THE CATARACT.
  The cataract is an opake state of the crystalline hu-
mour, or of its capsule, by which the rays of light are
obstructed in their passage to the retina.
                     SYMPTOMS.
  Imperfect sight or mistiness in vision ;—the  sensa-
tion of motes, particles of dust, flies, or other imaginary
objects, floating in the air, or attached to the eye ; the
patient  seeing better in a Aveak than in a strong light;
—an opacity becomes sensible, and gradually increases,
until  nearly a total  loss of vision is produced ;—the
crystalline lens gradually changes from a state of trans-
parency to a perfectly Avhite or grey colour ; in some
rare instances it has been black, and also red ; and in
appearance resembles a pearl, or  other extraneous
body of a like colour, situated immediately behind the 
THE CATARACT,
119
pupil.'—The  cataract varies in  its consistence, being
sometimes hard, at others entirely dissolved.
  Dr. Bere enumerates the following distinctive ap-
pearances :
  The  hard cataract is equally opake, has no specks
nor spots, is partially detached from the iris, so as fre-
quently to admit of objects being seen laterally ;—the
opacity  begins in the centre and sloAvly spreads ; its
colour is grey, or  more  or  less  inclining to  green.—
In the  operation, when  opening the cornea, the pupil
strongly contracts.
  The  soft cataract appears streaked or radiated, the
opacity begins uniformly over the whole surface, the
loss of  vision is more complete ;—it is of a shining
Avhite colour, approaches nearer to the iris,  and even
presses forward into the pupil;  the spots often change
their position, and upon  opening the cornea the pupil
does not contract.
  The  connate cataract  is almost universally in a dis*
solved  state,
  The  cataract produced by the opacity of the capsule
of the  lens, is distinguished by  it:-, peculiar shining
surface, and by  the appearance  of silver-like  lines,
forming radii or stars.
  In fluid cataracts  the capsule is also usually opake.
                    TREATMENT.
  In the  incipient  state—mercury, particularly calo-
mel, or hydrargyri muriatus, in small-doses.
  Electricity, in the form of aura, or Aveak sparks.
  Hyoscyamus has  been highly extolled.
  When  any degree of inflammation is  present, local
bleeding, and the antip'logistic regimen.
   After these remedies have been employed without 
*30               THE CATARACT.
success, the cure must depend upon a surgical opera-
tion.—For performing this, tAvo methods arc in general
use, each of which has its advocates.  The first of these
is called couching ;—the second is termed extraction.
         OF THE OPERATION OF COUCHING.
  To guard as much as possible against the  effects of
inflammation, the patient should be confined for several
days previous to the operation to a low regimen ;<—if
plethoric, he should be bled, and tAvo or three doses of
some cooling laxative should be  administered  after
proper intervals.—These and other necessary prepara-
tions being made, the patient should be so placed that
light may fall upon the eye in one direction only ;—he
should  be seated in a low chair ;  the  operator should
also be  in a sitting position, but more  elevated, his el-
boAv resting  upon his knee properly raised, his ring
and little fingers supported  upon the cheek or temple
of the patient.—The upper eyelid is to be elevated by
an assistant, and the lower depressed by the right hand
of the surgeon ; or the eye is to be fixed by means of a
speculum invented for the  purpose—The couching-
needle (the best construction of this instrument is that
recommended by  Mr. Hey—see his  Observations in
Surgery) is noAV to be entered in a horizontal direction,
through the sclerotic coat, a little below the axis of the
eye, and about a quarter  of a line beyond the transpa-
rent cornea, so as to get entirely behind the iris ; taking
care not to Avound this, by opposing'to it the flat side
of the  instrument, if a needle of this form has been
made  choice of.   Its point  is then to be pushed to-
wards the centre of the  eye (Mr. Hey) ; and, when
discernible through the  pupil, it  is to be fixed in the
body of the lens, if solid, is to be pushed down by one, 
THE CATARACT.
121
if fluid, by several movements, to the bottom of the
vitreous humour.—.The needle is then to be withdraAvn,
the eyelids closed, and covered with a soft compress
moistened with a  saturnine  solution, or  (as recom-
mended by Mr. Pellicr) covered Avith a linen bag, half
filled with fine avooI, applied dry, and fixed to a circu-
lar bandage passed around the forehead.—This should
not be  removed before the eighth day, during Avhich
time  the antiphlogistic regimen should  be strictly
enforced.
  Should the lens, before the absorption takes place,
regain its  former situation, a repetition of the operation
may become necessary ; and may even be performed
many times successively, not only with impunity, but
with  ultimate success.—.Vide Hey's  Observations in
Surgery.
          THE OPERATION OF EXTRACTION.
  The patient and operator being placed, and the eye
fixed as for couching, the point of the cornea knife (the
blade of this is formed like a spear-pointed lancet,—on
one edge it is sharp throughout its Avhole extent, on the
other only a short space from its point), Avith the cut-
ting edge doAvnwards, is to be passed  into the transpa-
rent cornea,  at  about one tAvelfth of  an inch from the
opake,  and as  high as the centre  of the pupil  ; it is
then to be carried forwards to the point opposite to that
at Avhich  it entered ;  this being pierced, it should
be again pushed on,  until, by its increasing breadth,
the outer angle of the  transparent  cornea  has  been
completely divided, and a semi-lunar flap has  been
consequently formed.   A small needle, invented for
the purpose, Avith a hook at its extremity, is uoav to be
introduced beneath the flap, to be passed cautiously
                         M 
122    WOUNDS OF THE EYELIDS, OR EYEBALL.

through the pupil, and Avith  it an opening is to be
formed in  the  capsule of the lens, by gentle and re-
peated scratches, with its curved  point.   This being
done, the  eye  is  to be shaded, to  allow the pupil to
dilate as much  as possible ;  after which, upon gentle
pressure being made upon  the eyeball,  at either the
Upper or under edge of the orbit, the crystalline lens
will pass out through the opening made in the cornea.
  When the cataract  does  not come out entire, or
Avhere it is found to  adhere to contiguous parts, the
small scoop should be introduced, to  remove any de-
tached pieces, or  adhesions, that may be present.
  When the opacity  is solely in  the capsule,  some
practitioners attempt to extract first the lens, and then
the capsule, by  the  forceps  or tenaculum ;  others
(Bere) the lens and  capsule entire ; detaching them
from their connexions by lateral motion with the needle.
-—In  many instances  it has become totally absorbed
after the extraction of its lens.—The subsequent treat-
ment will be precisely as above described*


 WOUNDS OF THE EYELIDS, OR EYEBALL.
  Superficial wounds of the eyelids may, in general, be
united by  slips  of adhesive plaster.—When deep, par-
ticularly Avhere the tarsus has been divided, the  inter-
rupted suture Avill be required.  In making this, care
should be taken that the stitches do not penetrate the
inner membrane, otherAvise much irritation and inflam-
mation will be  induced.—Inflammation  should be
guarded against, or if already present, removed by the
means recommended  under  the article Ophthalmia.
  Wounds of the cornea are most  commonly followed 
SPECKS AND FILMS.
i'U'.'.
by partial or total loss of the sight.—In any other part
of the eyeball the danger will be in proportion to the
extent of the Avound.—Pain  may be allayed by opium,
and a strict antiphlogistic regimen is to be enjoined.
              SPECKS AND FILMS.
  These occur in two different states.—The one arises
from an effusion immediately under the external layer
of the cornea ; in Avhich case the cornea does not ap-
pear to be raised.—.The other takes  place in conse-
quence of one or more little ulcers, Avhich breaking,
leave as many opake spots in the  centre, considerably
more elevated than the rest of the cornea.
                      CAUSE,
  Almost universally, preceding inflammation.
                    TREATMENT.
  In the first species, local applications are attended
with little or no advantage.—A long course of mercu-
rial alteratives, especially the hydrargyrus muriatus,—
brisk purgatives,—errhines  (vide Ophthalmia),—blis-
ters, and issues in the neck, are the means  Avhich have
been found most effectual in removing them.
  In the second species.—Dividing the vessels running
into the prominent part, by means of a circular incis-
ion ;—finely  levigated poAvders ;  as alum joined Avith
sugar,  aerugo, hydrargyrus nitratus  ruber,  calomel,
ossepiae, tutia preparata, powdered glass ;—a collyrium
of a Aveak  solution of hydrargyrus muriatus ;—the
ophthalmic  ointment. 
124         PTERGYRIUM OR EXCRESCENCE.
 UNGUENTUM OPHTHALMI-
    cum.  Pharm. Chir.
R. Hydrargyri nitrati rubri,
   Lapidis calaminaris prepar-
             ati, aa  3JSS<
   Lithargyri laevigata >jj.
   Tutiae preparatae %ss-
   Hydrargyri sulphurati rub-

   Balsami Peruvians gutt. xv.
   Adipis suillae preparatae 5ij.
 OPHTHALMIC OINTMENT.

Take Red nitrate of mercury,
 Prepared calamine, each ^\ss:

  Levigated lytharge X\.
  Prepared tutty ^ss.
  Red sulphuret of mercury ^i,

  Balsam of Peru dreps xv.
  Bog's lard ?ij.
The powders being well  rubbed together and mixed
  with the lard, the balsam of Peru is lastly to be added.
Or
Take White oxyd of mercury,
  Prepared tutty
  Prepared calamine, eachZij.

  Compound tincture of benzo-
                ine Ji.
  Bog's lardZfn].
            Yel
R. Calcis hydrargyri albae,
   Tutiae preparatae,
   Lapidis calaminari s prepar-
         ati sir.gulorum Jij.
   Tincturae  benzoes compo-
           site 5J.
   Adipis suillae preparatae Jiij.
The  Avhite calx  of quicksilver, tutty, and  calamine,
  being rubbed separately, and afterwards well mixed
  together, the lard is next to be joined, and, lastly, the
  tincture of benzoes.
  The aqua cupri ammoniati;—caustic lightly applied
until  some degree of  pain is created ; and afterwards
long-continued ablution Avith Avater.—In films  or  opa-
cities of the cornea, animal gall has been applied  Avith
success.
      PTERGYRIUM, OR EXCRESSENCE.
  This is a  membranous excrescence, often  found
upon the  Avhite  part of  the  eye, which  frequently 
ABSCESS OF THE EYE,
125
spreads over the cornea, so as entirely to destroy vis-
ion.—It is  sometimes attended  with  great  pain, and
has terminated in cancer.
                      CAUSES.
  External injury ;—inflammation ;—scrofula ;—lues
venerea.
                   TREATMENT.
  The careful application of caustic, as directed against
specks in the eye ;—excision,—a division of the vessels
Avhich supply it with nourishment, by  means of a scar-
ification made completely round its circumference.
                    ABSCESS.
  A collection of matter in the  eye in consequence
of ophthalmic inflammation.—This must necessarily
take place betAvixt one or other of the coats of the eye,
varying in its  quantity and extent in different cases—
Often, when deep seated, a purulent matter is apt to be
formed in some of the chambers of the eye, Avhich kind
of abscess is called Hypopion, when the ball becomes
enlarged, the  humours disturbed, and neither the iris,
pupil, nor lens, can be  distinguished—The external
appearance of the ball becomes altered, irregular, and
full of protuberances.—While the disease is forming,
besides the loss of sight, the patient feels great distress
in the eye and  head, and the usual symptoms of fcArer.
__The deposition is discharged, either naturally, or by
the assistance  of art.
  An abscess lodged  in the substance of the coats of
the eye is not  an  unfreque  t consequence of variola :
it is also sometimes produced by external injury,
                        M2 
126          FUNGUS OF THE EYE,
                   TREATMENT.
  The collected matter should be evacuated by an in-
cision made into the eye, in the most prominent part of
the tumor.—Inflammation is aftenvards to be obviated
by the most rigid antiphlogistic regimen, and by the
means recommended for the treatment of ophthalmia.


                     ULCER.
  Ulcers on the eye arise from the same causes Avhich
produce  ulcers on other  parts of the body, as  acci-
dental injury, wounds, burns, Sec—They may also be
the consequence of a general affection of the constitu-
tion ; as, lues venerea,  scrofula, Sec.—They are more
immediately produced by inflammation.
                   TREATMENT.
  If inflammation  be present, this should first be re-
moved by appropriate means ; after which their man-
agement must be  nearly the  saine as that of similar
affections  in  other.parts ;—the cremor lithargyri ace-
tati Ph. Chir.  is a good application.  See  Inflammation^,
  If cicatrization proceed sloAvly :—
  Astringents and tonics, in the form of solution or
ointment; as, zincum vitriolatum,—hydrargyrus mu-
riatus,—a solution of alum,—an infusion of galls, or
oak bark.—The application of absorbent poAvders ; as)
lapis calaminaris.
  If there be great attendant pain, opium, or the poppy
fomentation.


                    FUNGUS.
  Fungous excrescences, sometimes considered as a
c'ancer ©f  &e eye, are apt to, form as a consequence of 
        TUMORS AND WARTS ON THE EYELID.     12/

both the preceding diseases—In some rare instances,
also, excrescences of a fungous nature are found to be
connected with the interior parts of the eye, and to be-;
come so prominent as even to rest upon the cheek.
                    TREATMENT.
  When small  in  size, gentle  escharotics—alumen"
ustum ;—the lunar caustic, with subsequent solution*
  When large, excision, or ligature.
            HORDEOLUM, OR STYE.
  This is a small abscess, seated in the edge of the
eyelid, and  produced by an obstruction in one of  its
sebacious glands.—It is attended with heat, stiffness,
pain, and considerable irritability.
                    TREATMENT.
  A small emollient poultice ;—an opening made with
the pofrit of a lancet, and afterwards the application of
"the unguentum hydrargyri nitrati.


  STEATOMATOUS TUMORS AND WARTS;
  Small encysted tumors and warts are apt to fornj
about  the eyelids, and  occasion much inconvenience
and deformity.
                    TREATMENT.
  Of the first.—A careful extirpation, as directed foij
tumors of this kind situated in other parts (see Em
cysted  Tumors) ;—and if the situation will admit,
adhesive plaster may be applied to effect an union,
otherAvise the part should be  daily covered with some
bland liniment, 
138          INVERSION OF THE CILIA.

   Warts may be removed  by ligature, or excision,
guarding against subsequent inflammation by refriger-
ant lotions, or small emollient cataplasms.
TRICHIASIS, OR INVERSION OF THE CILIA.
  In this disease the eyelashes  are  so much inverted
as to rub upon the eye, and produce much pain and
inflammation.
                      CAUSES.
  The hairs themselves taking  a wrong direction ;—
inversion of the tarsus ; cicatrix of this part in conse-
quence of a wound, or ulcer;—tumors pressing the
hairs in upon  the  eye ;—a relaxation of the external
integuments.
                    TREATMENT.
  Extraction  of  the eyelashes—If inflammation be
present, the local applications recommended for  oph-
thalmia—When arising from the presence of tumors,
the removal of these—When from cicatrix on the in-
side of the eyelid, this should be divided by an incision-
—If from an inversion of the loAver lid, produced by
relaxation, excision of a transverse fold of the integu-
ments, and consequent union by  the  first intention (by
the interrupted suture) ; strong astringents ;  or the
part may be drawn back, and long retained in that situ-
ation, by means of adhesive plaster.—If from an inver-
sion of the upper lid, from the same cause (a relaxation
of the levator  palpebrae), the most  powerful astrin-
gents.
  A case is  related by Mr.  Ware, in Avhich an  opera-
tion, performed as follows, was attended with success ;
—An incision having been  made through the integu- 
CONCRETION OF THE EYELIDS.        12$
ments, from the inner to the outer angle of the eye,
the fibres of the orbicularis muscle Avere separated, and
the expansion of the elevator exposed ; after Avhich a
small cauterizing iron, adapted to the convexity of the
globe of the  eye,  Avas made pretty Avarm, and passed
two or three times over the tendino-carneous  fibres.
   When the disease  proceeds from a contraction  of
the orbicularis,  enlarging the circumference  of the
ciliary edges, by means of an incision made at the outer
angle of the eye.


      RETORTION OF THE EYELIDS,  OR
                  GAPING  EYE.
   This consists in a large portion of the eyelid being
turned outwards;  by Avhich  too much of the  eye h
exposed.
                      CAUSES.
   Dropsical  SAvellings of  the eye ;—cicatrix from
sores,  produced  by inflammation,  variola, syphilis,
scrofula, &c.;—laxity of the part in old age.
                    TREATMENT.
   If the disease proceed from the  first of the causes
 above  enumerated, recourse  is to be had to  the treat-
 ment afterwards to be mentioned.—If from cicatrix,
 division of the contracted part by an incision—If from
 debility, or laxity, cold and  astringent applications.


        CONCRETION OF  THE  EYELIDS.
   This is mostly  the consequence of a high degree of
 ophthalmia.—A cohesion  may  either take place be 
ISO
PROTRUSION OF THE EYE.
twixt the lids themselves, or the lids may form adhe-
sions to the surface of the eyeball.
                   TREATMENT.
  When slight, the adhesion may be removed by the
end of a blunt probe, passed betAveen the lids.—When
more considerable, a cautious dissection will be neces-
sary.—A feAv drops of bland oil should afterwards be
applied to the eye, and  every precaution taken to pre-
vent the accession of inflammation and irritation.
             DROPSY OF THE EYE
  Consists in a preternatural accumulation of the aque-
ous humour—It is attended by a sense of fullness in
the eyeball ;—the motions of  the eyelids, by degrees,
become impeded ;—vision gradually becomes more
and more imperfect, till  at last  the patient can only
distinguish light from darkness.—The ball of  the eye
becomes gradually enlarged ;—the  cornea begins to
protrude, and, if suffered to proceed, at length bursts,
and the fluid is discharged.
                   TREATMENT.
  A puncture or incision  made at the under  edge of
the cornea,  into the anterior  chamber of  the eye, or
through the sclerotic coat, into the posterior ;  of suffi*
cient extent to admit of the evacuation of the fluid,
          PROTRUSION OF THE EYE.
  A protrusion of the eyeball beyond its socket is not an
unfrequent effect of external violence ;—it may also be
produced by tumors  forming behind it, by a dropsical 
CANCER OF THE EYE.
131
affection of the eye itself, or by an enlargement of the
lachrymal gland.
                   TREATMENT.
  When the consequence of external injury, if the eye-
ball  be not entirely  separated from the  neighboring
parts,  it should be carefully freed from  extraneous
matter, and returned to its situation ;  Avhen the faculty
of sight will often be recovered, should the optic nerve
remain uninjured.—When  it arises  from collections
within the eye itself, these are to be evacuated.   See
       rue    .    '2?                    ,          i
Dropsy and Abscess.—Other causes are to be removed
by the means proper for each,
                    CANCER,
                    SYMPTOMS.
  Enlargement,hardness,and protrusion of the eyeball;
—lancinating intermitting pain, extending to the side
of the head ;—sensation of burning heat in the part;—
a red fungus soon makes its appearance, which often
increases until it attains a large size, and discharges a
thin excoriating ichor.
                    TREATMENT.
  In the early stage, inflammation and pain should be
moderated by blood-letting, emollient applications, opi-
um, poultices of cicuta, lotions composed of a solution
of opium in lime-water.
  In the advanced stage,  the safety of the patient can
only be ensured by an operation.
                  THE OPERATION.
  The  diseased eyeball is to be firmly secured in  a
proper situation, by means of a tenaculum, or double
hook, held in the left hand of tae operator; while with 
132
FISTULA LACHRYMALIS.
the other he separates the whole of the diseased from
the sound parts, and completely extirpates the eye by
means of  a knife, so bent as  to correspond with the
sides of the orbit; at the same time carefully guarding
against Avounding the  periosteum, or  doing injury to
the bones.—The eye being thus removed, the haemorr-
hage, if there be any, should be suppressed by means
of compresses of  lint  or sponge ; covering  the Avhole
with soft dressing, and moderating the consequent in-
flammation by the most  rigid observance of the anti-
phlogistic regimen.
  The deformity  unavoidably produced may  in some
measure be obviated by Avearing an artificial eye.


          FISTULA LACHRYMALIS.
  Fistula laciuymalis is a sinuous or fistulous  ulcer of
the lachrymu sac  or duct.—Its progress to this state
may be d^ i ted into three stages.
                    SYMPTOMS.
  Of the first stage.—A small tumor  betAveen the in-
ner corner of the eye and  side of the nose, Avhich dis-
appears ■  ion pressure, but soon returns after the com-
pressing cause is removed.  The eye is constantly
moisten! .1 with tears mixed with  mucus, which  also
frequently Aoav over the cheek.—Sometimes  a slight
ophthahnia,  or  inflammation of the eyelids, succeeds,
and the latter are often  found  glued  together upon
aAvaking from sleep.—The  disease in this state  has
been called the watery eye, or dropsy of the lachrymal
sac.
  Of the second stage.—The swelling enlarges in size,
inflames, and suppurates; there is considerable pain 
FISTULA LACHRYMALIS.           13'3
and discolouration, and, upon pressure, pus is discharge
cd from the puncta lachrymalia.
   Of the third stage.-^-hX length the abscess bursts ;
if the aperture be small, it frequently heals and bursas
alternately, until the opening becomes sufficiently large
to prevent  any further collection,—The disease in this
state exhibits  the appearance of a sinuous ulcer,' with
callous, sometimes Avith retorted, edges  and hoav forms
what is properly the fistula lachrymalis.—The passage
from the sac  into  the nose is completely  obstructed,
and tears, mucus,  and purulent matter, are abundantly
discharged, and Aqav down the cheek.—In some instan-
ces the contiguous bone becomes carious.
                       CAUSES.
   Remote.—Scrofulous inflammation of the membrane
lining the nose ; pustuies arising in the  duct, in  conse-
quence of  exanthematous diseases ;—syphilitic ozaena,
__or ulceration of the mucous membrane of the nose
from Avhatever cause.
   Proximate.—An obstruction of the lachrymal duct,
from contraction and thickening of its membrane.
                    TREATMENT.
   In the early stage of the disease, attempts should be
 made to remove the obstruction—by means of a small
 probe introduced at one of the puncta lachrymalia,  and
 passed through the sac and  duct into the nose ■;—by sy-
 ringing aqueous fluids through the puncta—it has been
 proposed to inject quicksilver by the same  manner;—
 by repeated and frequent, or  constant pressure on the
 sac ; the latter either by means of an instrument invent-
 ed  for the purpose,  or  by  simple  compress  or ban*
 t:age.
                         N 
134
FISTULA LACHRYMALIS.
   In the inflamed  state, local bleeding  by leeches ;—
 laxatives,—sedative and refrigerant lotions.  See Oph-
 thalmia.—-An incision into the tumor ; and after the in-
 flammation arising from it has subsided, the nasal duct
 should be searched for Avith a probe, and,  Avhen found,
 a piece of catgut bougie should be introduced and kept
 there, its edge  being bent a little doAvmvards, till the
 sides of the duct are skinned over and healed.
   Mr. Ware recommends the following mode of "treat-
 ment :—If an aperture into the lachrymal sac has not
 already been spontaneously formed, or if it be formed
 in an improper situation, a puncture  should be made
 into it, Avith a common spear pointed lancet, at a small
 distance from the  internal juncture of the  palpebral,
 just under the  tendon of the orbicularis muscle, and
 about one fourth of an inch Avithin the ridge of the or>
 bit.  The blunt end of a small silver probe is  then to
 be introduced through the wound, and gently but stead-
 ily pushed on in the direction of the nasal duct, with a
 force sufficient to overcome the obstruction  in this ca-
 nal ; it is then to be  Avithdrawn, Avhen a small silver stile,
 Avith a  flat head, like that of a nail,  is to be introduced
 into the place it occupied, and to be left constantly in
 it; Avithdrawing it  at first daily for about a week, after-
wards every  second or third day.—-Some warm Avater
 should each time be injected through the duct into the
 nose, and after this the instrument  should be replaced
 in the same manner it Avas before, and its head covered
 Avith a piece of diachylon or court plaster.—.The length
 of time required for the cure of the disease -will be va-
 rious;  after the expiration of a month  or six Weeks*
 the  instrument  may occasionally be discontinued, and
 again employed should the  cure not have  been effect-
 ed.—Where the disease has been of lung standing, and 
               DISEASES OF THE EAR.            135

the duct and contiguous parts have become so diseas-
ed as not to admit the introduction of the probe or sti-
letto, an artificial opening should be made through the
os unguis into the nose, by means  of a curved trochar,
introduced in the direction above recommended for the
puncture ; after which the  stile or bougie  should be
passed into the opening thus formed,  and Avorn as al-
ready described.
  Other modes of treatment have  been recommended,
as the introduction of a canula into the nasal duct, &c.
but_ they have  been found liable  to objections, from
which the above seems exempt.
         OF DISEASES  OF THE EAR.
   The diseases of this organ are numerous, and their
effect is generally a partial or total destruction of the
function of hearing,


   INFLAMMATION AND  SUPPURATION.
                    SYMPTOMS.
   Considerable pain darting through the ear,—redness
and heat; these either gradually diminish, and at length
entirely  cease ; or matter is formed and discharged at
the meatus.
   Chronic ulceration  is not  unfrequently the conse-
quence of the disease ; Avhen a discharge of an acrid fe-
tid matter from the ear becomes habitual.
                   TREATMENT.
   In the inflammatory state.—Water as Avarm as the
patient can  bear, frequently poured into the meatus au-
ditorius; or the introduction of soft avooI dipped in the 
136     ACCUMULATION OF WAX IN THE EAR.
 common decoction for  fomentations.—Blisters behind
 the ear.
   In the chronic state.—Injections of a solution of vit-
 riolated zinc, p. 51;—of hydrargyrus muriatus dissolv-
 ed in aqua calcis :
 R. Hydrargyri muriati gr. X.   Take muriate of mercury grs, X.
   Aquae calcis Jfjj.             Lime water j;fcj.
 Fiat injectio.                 Make an injection.
   The union of balsamum Peruvianum with gall:
 R Fellis bovini Jiij.           Take Ox Bile Jiij.
   Balsami Peruviani Jj. M.     Balsam of Peru Jj. Mix.
 A drop or two to be put into the ear with a little cotton,
   Setons  or perpetual  blisters as near as-  possible  to
 the ear.
   Amber.  Etmuller.
   A grain of musk introduced into the ear with cotton-
 wool.  Brookes.

          ACCUMULATION  OF WAX.
   An accumulation of indurated  wax in the ear is one
 of the most frequent  causes of deafness.
                     TREATMENT.
   The introduction of a small portion of oil of almonds,
 dropped upon cotton, and after  suffering it to remain
 for a day or two, syringing the ear with warm milk and
 Avater, or solution of soap ;—or common salt, Avhich is
 used by Dr.  Haygarth as the best solvent of the accu-
 mulated Avax.
 R. Natron muriati Jj-         Take muriate of Soda ^j.
   Aquae distillatae. q. s.         Distilled water q. s.
 Fiat injectio.                Make  an injection.

 R. Saponis Hispanici ±ss.      Take Castile Soap 5ss,
   Aquae distillate fyj.           Distilled water j-j-jj.
Fiat injectio.                Make an injection. 
        OL«SIN© OF THE EUSTACHIAN TUBE.     137

            DEFICIENCY OF WAX.
  Deafness is sometimes the consequence of a morbid-
ly dry state of the ear, arising from a defective action
in the glandulae cerumineae.
                   TREATMENT.
  The application of volatile and stimulating substan-
ces to the membrane lining the ears, by means of cot-
ton, avooI, Sec;—the linirnentum ammoniae.—Oleum
terebinthinae diluted Avith oil of almonds.  Mr. Maule.
  CLOSING  OF THE EUSTACHIAN  TUBE.
              DIAGNOSTIC SYMPTOMS.
  It is preceded by some disease of the nose or throat;
as, coryza, aphthae, enlargement of the tonsils, Avant of
secretion in the parts, &c.—Upon an  effort to expire,
at the same time  retaining the breath by stopping the
mouth and nose, there is no sense of distention of the
tympanum.—The sound of the patient's  voice appear-
ing more dull  to himself than the voice of  other peo-
ple ;—constant noises referred  to  the  affected ear;
these are described as sometimes resembling the hiss-
ing of a teakettle, at others like the running of Avater,
high Avind bloAving through trees, or even like thunder.—
Persons deaf from this cause  hear better in  a carriage,
or in any considerable noise.   Dr.  Sims, Memoirs  of
the Medical Society.
                     CAUSES.
  Obstruction of the  Eustachian tube in consequence
of venereal affections  of the throat;—ulcerations of the
fauces or nose  from other causes;—common cold affect-
ing parts contiguous  to the orifices of the tube;—the
                        N2 
13S     ATONY OF THE MUSCLES OF THE EAR.

pressure of tumors ; the presence of inspissated mu-
cus ;—extravasation of blood in the cavity of the tym-
panum.  Cooper.
                   TREATMENT.
  When the  tube is only  slightly infracted Avith gluti-
nous matter,  repeated swalloAving, gaping, yawning, or
gurgling, have in some  instances removed it.—What-
ever forces a current of air into the tube ;  as speaking
loudly,—coughing,—sneezing,—retention of breath, at
the same time making an effort to  expire.
  If the inflammation be present, cupping,—the appli-
cation of blisters,—the insertion of issues in the neigh-
bourhood of the  part.
  Syringing  the Eustachian tube  from the nose or
mouth.  Dr. Sims.
  Perforation of the mastoid process, and thereby re-
Storing the communication between  the external ait
and the cavity of theEustachian tube.  Haighton in Me-
moirs of the Medical Society.
  A puncture made through the membrana tympani,
by means of a sharp probe.  Astley Cooper Philosophi-
cal  Transactions.


                    POLYPUS.
  The polypi appearing in the ear are of the  same spe-
qies, and require  precisely the same treatment, as those
of the nose.   See Diseases of the nose/*''


  ATONY OF  THE MUSCLES OR  NERVES
                 OF THE  EAR.
  A loss of tone in the muscles  and nerves concerned
ill the function of hearing, may be induced by previous? 
       IMPERFORATED MEATUS AUDITORIUS.     139

debilitating diseases, as fever, 8cc.;  or by paralysis of
these parts consequent on cold.
                   TREATMENT.
  Electricity—the electric aura ;—powerful  stimuli,
as oleum terebinthinae, or aqua ammoniae, properly di-
luted.


     THE  DEAFNESS OF OLD  PEOPLE
  Is most commonly owing to a relaxation of the tym-
panum ; is usually accompanied with confused sounds.,
and noises of various kinds, referred to the ear.
                   TREATMENT.
  Hot  stimulating oils applied by means of avooI ;—the
spiritus ammoniae compositus united Avith tinctura lav-
endulae;—the use of an instrument invented  for the
purpose of collecting sound


    EXTRANEOUS BODIES IN  THE EAR.
  These may  often be extracted by means of a small
forceps, or  by syringing the ear Avith tepid water.—
Should these means be unsuccessful, they may be suf-
fered to remain Avith impunity if they do not produce
pain, as in a short time they will be  forced out Avith the
accumulating Avax.
  Insects may be killed  by filling the ear with oil,  or
any other  fluid, and after Avards be removed by injections
of Avarm Avater.


   IMPERFORATE MEATUS AUDITORIUS.
   The external passage of the ear is  sometimes covered 
140       H.£MGRRHA»E FROM THE NOSE-

with a thin membrane ;—at others the cavity is filled
up by a fleshy substance, occasioning perfect deafness;
                   TREATMENT.
  An incision continued until a resistance is no longer
felt to the passage of the knife or lancet;—the Avound
afterwards kept open by the introduction of dossils of
lint.
OF DISEASES OF THE NOSE AND ITS
             APPENDAGES.
    OF HEMORRHAGE FROM THE NOSE,
                   TREATMENT.
  The local  means employed for the suppression of
haemorrhage from the nose, are—.dossils of lint intro-
duced by means of a probe, and moistened Avith a strong
solution of alum,—of zincum vitriolatum,—or cuprum
-vitriolatum ;—the gut of a small animal, tied at one
end, pushed to the further part of the nostril, and filled
with vinegar and water, or an astringent solution,  and
aftenvards secured by ligature.
  A small pledget of lint covered  with pulverized
alum, or moistened with one of the astringent solutions
above mentioned, conveyed to the posterior aperture
of the nostril, by attaching it to a waxed thread or piece
of catgut, the other extremity of which has previously
been  passed  through  the  nose  into  the  throat,  and
thence dravra with a forceps into the mouth.
  For the medical treatment of Epistaxis, consul'*
writers on the practice of physic 
POLYPI IN THE NOSE.
141
                     POLYPI.
  These are tumors formed from the membrane lining
the nose.—Of these there are two species ;  the com-
mon, and the cancerous.
                    CHARACTER.
  Of the common polypus.—It is pendulous, and hangs
by a small pedicle ;—it is moveable within the nose ;—
its  size is  influenced by the state of the weather, the
protrusion being greatest when hazy and damp ;—it is
of the natural colour of the skin, or of a faint red, in
some degree transparent,  and free from  pain ;—it
sometimes projects  from  the anterior,  sometimes
from the posterior, aperture into the nose.
  Of the cancerous polypus.—This is much  harder in
its texture than the preceding ;—it is of a livid colour ;
—its surface  is irregular ;—it  is attended Avith a pe-
culiarly  pungent and lancinating  pain ;—it ulcerates,
discharges a fetid  matter, and if not extirpated, goes
on  to the  destruction  of  the  nose, and contiguous
parts, and ultimately the life of the patient.
                   TREATMENT.              \
  Of the first species.—The topical use of astringents ;
as alum, oak-bark, vinegar, ardent  spirits.—If, these
prove ineffectual,  removal  by  excision, by  means of
scissars ; or ligature, applied  by  means of  the tonsil
instrument.—It may be sometimes successfully drawn
forcibly  away with the forceps.
  Of the second species.—Excision, or forcible extrac-
tion, if  practicable ;—the internal and external use of
opium and cicuta;—and injection of tinctura ferri mu-
riati, and the oxygenated muriatic acid diluted. 
142
IMPERFORATE NOSTRIL.
B. Tincturse ferri muriati 5j •

   Aquae distillatae ?vij.
Fiat injectio.

B. Acidi oxy-muriatici ?j.
   Aquae distillatae ?vij.
Fiat injectio.
Take  Tincture of muriate  of
              iron  iri.
  Distilled water  ivij.
Make an injection.
Take Oxy-muriatic acid 5i.
  Distilled water 2vij.
Make an injection.
                      OZCENA.
  A discharge of purulent mucus from the nose, pro-
duced by an inflammation and ulceration of its mucous
membrane.
                        CAUSE.
  Cold ;—any thing producing an irritation of the part;
—all the causes of catarrh ;—external violence ;—sy-
philis.
                     TREATMENT.
  Astringent injections ; as, a decoction of bark Avith
alum, a solution of hydrargyrus muriatus, or of zincum
vitriolatum.—Blisters to the temple.—The water-dock
taken internally is said to have removed the  complaint.
R. Ahimnis purificati ?ss.     Take Rock alum 5ss.
   Decccti quercus ^xij.         Decoction of oak bark 5xij.
Solve pro injectione.
Dissolve J'or an injection.
R. Hydrargyri muriati g. vj.
   Aquae distillatae 5viij.
Solve pro injectione.
Take Muriate of mercury gr. vi-
  Distilled water ?viij.
Dissolve for an injection.
        IMPERFORATE NOSTRIL.
The passage into the nose may be cither originally 
CANCER OF THE ANTRUM.
143
imperforate, or it maybe closed by accidental injury or
disease, as burns, small-pox, venereal or other ulcers.
                   TREATMENT.
  An incision made Avith a lancet or common scalpel ;
and the opening prevented from closing, by the intro-
duction of dossils of lint, or a metallic tube, into the
nose.


     COLLECTIONS OF MATTER IN  THE
          ANTRUM OF HIGHMORE.
                    SYMPTOMS.
  Pain extending upAvards to the eyes, nose, and ears ;
--swelling and redness of the integuments over the
part;—frequently on a sudden, and especially upon
rising from bed, a discharge of matter issues from the
nose, Avhich affords a relief to the symptoms until the
cavity  becomes again distended.
                   TREATMENT.
  The extraction of the  first  molar tooth is recom-
mended, and  evacuating  the matter by means of a
puncture made, through the alveolus, Avith a stilette or
sharp-pointed instrument;  and after the  contents of
the  cavity  have  thus been emptied, preventing the
sides of the opening from closing, by means of a plug
or bougie ; and occasionally injecting tincture of myrrh,
or some  astringent fluid.


        OF CANCER OF THE ANTRUM.
   This is supposed to originate in a polypus of a na-
ture similar to  that already described as occurring in
the nose. 
144
THE HARE LIP.
   It may be expected to exist, by the chronic enlarge*
ment of the part, and by the peculiar and characteristic
cancerous  pain ;—the  true  nature of the  disease is,
however seldom ascertained, until it has extended its
ravages to  the nose and  neighboring parts, and pro-
duced the  most horrid deformity.—It at length termi*
nates fatally.


 COLLECTIONS OF MATTER IN THE FRON
      TAL AND  SPHENOIDAL SINUSES.
                    SYMPTOMS.
   Pain and  considerable SAvelling of the brow?—tender-
ness to the touch,—alteration of the voice,—frequent
flow of tears ;—after some continuance of these symp*
torns, a sudden gush of matter issues from the nose,
and the symptoms  are relieved.
                  TREATMENT.
  Little can be  done  ;  the disease being out of the i
reach of the usual remedies.—A blister applied to the '
temple or  forehead, and kept open Avith ceratum can-
tharidis, Las been  employed with success__The pain
may be relieved by opium.
DISEASES OF THE LIPS,
                  A HARE LIP.
  A fissure generally in the upper lip, and sometimes
extending to the bony palate, Avhich, by causing a pre-
ternatural projection, creates some resemblance to the
lip of a hare. 
THE HARE LIP,
i45
                 THE OPERATION.
  The deformity may in a great measure be removed
by an operation.—In performing it, the first step is the
separation of the adhesions to the gum which usually
exist at the fissured part ; after Avhich, by means of a
cataract-knife  or  common lancet, the edges of the
opening are to be successively pierced at the upper
part, and by carrying the  instrument forwards along
their Avhole extent,  a thin portion of the edge is to be
cut off, so that an entirely raAV surface may remain, to
be  united by the  first  intention.   The sides of the
wound are  to be accurately brought together, and re-
tained in their  situation by means of  small pins made
of silver with steel points, Avhich, when inserted, Avith
their attached ligatures, have obtained the name of the
twisted suture.—In  the adult  three  pins will be re-
quired ;  the first sliould be inserted as near as possible
to the red part  of the lip,—the second should be passed
near to the  upper  angle  of the fissure,—the third
should occupy a middle space between the tAvo.   In
passing them from one side of the fissure to the other,
care should be  taken that they do not  completely pen-
etrate the substance of the  lip.—In children two will
be sufficient.—After the insertion of the pins,  a waxed
ligature  is to  be applied upon each, by being passed
repeatedly under and over-from side to side,  so as to
describe the figure 8.   By these means the edges will
■be retained in contact, and the wound  will  be  closed,
with little deformity.
   In children the operation  should be deferred until
they have been weaned.—Should there be a fissure on
both sides, the second operation should not  be per-
'ormed until the first cure has been effected,—In cases
                         O 
146
CANCER OF THE LIP.
where the bony palate is also defective, the dentists
have invented an artificial one of silver.


                    CANCER.
                    SYMPTOMS.
  This disease, Avhen occurring in the lip, generally
eommences Avith a small crack, Avhich becomes exqui-
sitely painful, and upon  examination, is found to be
formed in a small, hard, deep-seated tumor.—The pain
soon becomes more  intense, and is pungent and lanci-
nating ;—ulceration  ensues, and if its progress be not
timely suspended, the life of the patient  is endangered
by an extension of the disease, first to the glands of the
neck, aftci'Avards to other parts of the body.
                    TREATMENT.
  The most certain mode of obtaining a cure is the
excision of the part.—This, Avhen the disease is not far
advanced,  may be readily done by an incision on each
side of the diseased  portion, made in a  direction suffi-
ciently oblique, as that the union of  the two may form
an angle at the inferior part of the tumor  ; and after the
extirpation of which, that the sides of the wound may
be brought together, and united either by the tAvisted
or by the interrupted suture.
  After the disease  has become more extensive, such
mode  of treatment  will be impracticable ; a free and
perfect excision of  the  part should be  made, and the
Avound suffered to fill up by granulations.
  Arsenical  caustics have been used with success in
the early stage of the disease.—Various other applica-
tions are also reported to have effected cures ;  as the
constant application of the  root of a large common-
onion,  &c. 
SIBBENIC ULCERS.              14-7
  Professor Hufeland relates a case in which the aqua
ammoniac, with a decoction of the sprigs of the pine,
Were effectually employed.
          SARCOMATOUS TUMOR.
  An accretion of the skin and integuments of the lip
not unfrequently takes place, which so much resemble
cancer, as to have been often mistaken for it.—It is dis-
tinguished from that disease, by the absence of pain and
ulceration.
                   TREATMENT.
  It may,  Avhen small, be readily  removed by eschar-
otics ;  and Avhen  large, by  excision  performed as
above recommended for cancer.
DISEASES OF THE INTERIOR OF THE
                 MOUTH.
                    APHTHA.
  Vide  Exanthematous Diseases, and the Diseases of
\Children, in medical works.
              SIBBENIC ULCERS.
  These are small  superficial ulcerations of the ton«
 Is, uvula, and sides of the tongue, that accompany the
 Sbbens, a cutaneous disease which attacks the inhabi-
tants of the northern part of this island.—Their edges
 e  thick and  sAvcllcd, their surface covered with  a
/ 
T4S
TONGUE-TIED.
 white slough, which gives them much the appearance
 of venereal sores.
                   TREATMENT.
  The topical use of a  solution of hydrargyrus muri-
 atus, page 142 ;  and of argentum nitratum, page 51 ;—
 the pilulce hydrargyri internally.  Ferguson in Medico I
 Journal.


             MERCURIAL ULCERS
  Are ulcerations in the mouth, produced by mercury ;
 superficial, and having a dark-coloured surface.—They
 are accompanied Avith fetid breath, Avith a taste in the
 mouth resembling that of copper ; the gums are sep-
 arated from the teeth, and the tongue is covered with a
 glairy fluid,
                   TREATMENT.
  The use of mercury should be discontinued, and the
 mouth frequently Avashed Avith emollient  and slightly
 astringent gargles of infusion of roses with alum, or
 decoction of  oak-bark, Avhile sulphur and alkalies are
 administered  internally.


                TONGUE-TIED.
  It A^ery frequently happens that the tongue of infants
 is tied, that is, that the fraenum linguae is so short as to
 prevent the tongue from being protruded to, or beyond,
 the gums; in which case an operation becomes neces-
 sary for dividing the fraenum by Avhich it is confined.
              CUTTING THE  TONGUE.
  In performing this, some little  care and steadiness
■*re required, or the sublingual veins and arteries mav 
RANULA.
149
be wounded,  and the infant die of haemorrhage.  To
avoid the danger, a small cun^ed bistoury may be used
instead of scissars usually employed.  The handle and
blade, Avhen open, need not exceed two inches in length;
and the point should be a little curved, and the back
made broad, Avhereby the point may be easily forced
through the fraenum, in the most troublesome case,
while the back of the instrument will sufficiently press
down the vessels,  so that they  will be entirely out  of
the Avay of being injured.
                    RANULA
  It a  little inflammatory or indolent tumor, situated
under the tongue, by the side of the ranular artery, on
either side of the fraenum.—It is of greater or less size ;
sometimes acquiring such magnitude as to impede the
motions of the tongue, obstruct the speech, and in chil-
dren, who are equally subject to the affection as adults,
prevent the action of sucking.—Its contents are various;
generally a fluid resembling saliva; at others a glairy
matter like that found in the cells of swelled joints ; and
then a fatty or carious substance.—Its cause is suppos-
ed to be  an obstruction of the salivary ducts, arising
from either cold, inflammation, calculary concretions,
kc.—It is attended with little or no pain.—In  some
cases it long remains in an indolent state ; in others, it
soon acquires a considerable size, spontaneously bursts,
and leaves an ulcer extremely difficult to heal.
                   TREATMENT.
  The usual applications to this disease are powerful
aslringents ; as, the mixture  of mel rosae Avith vitriolic
add, or a solution of alum,  and with these the tumor
                       02 
-Ut
CANCER OF THE TONGUE.
should be rubbed by means of a piece of lint attached to
•a probe or skeAver.
B. Mollis rosae 5-'lV-         Take honey of roses 3x'lV-
   Acidi sulphurici diluti Jij-     Sulphuric Acid diluted Jij-

  When these are  ineffectual, incision or  extirpation
has usually been resorted to;—but AA'hen the  cause of
obstruction proves to be of a more permanent nature,
the ulcer consequent upon  the bursting, or cutting in-
to the tumor, is often not to be healed by any of the
customary astringent  or escharotic  applications, until
its complete removal,
             VENEREAL ULCERS,
  Vide Syphilis. 4fc  J**cs %/piP .


             SCORBUTIC  ULCERS.
  Vide  Scorbutic Ulcer, page 57; and medical works
on Scurvy.
         CANCER OF THE TONGUE.
  Cancer of the tongue usually makes its appearance,
with a small fissured tumor in its side, exactly similar
in appearance to the same disease when occurring in
the lip.—Its progress and termination are also similar.
                   TREATMENT.
  Arsenical caustics may first be employed ; and if no
success results from their use, excision of the cancer-
ous part will become necessary 
          DIVISION OF THE PAROTID DUCT.       I9I

  CALCULUS OF THE SALIVARY GLANDS.
  All the  salivary  glands are subject to the formation
of calculi.—They produce much inflammation and pain,
and are  generally attended with spasms of the neigh-
bouring muscles, especially after eating.
  A curious case is related by Mr. Hewitt, surgeon at
Hull, of a  lady Avho discharged a calculus from the ton-
sil gland at every  period of pregnancy,
                   TREATMENT.
  An incision over the seat of the calculus, in the gland
or its duct; after  which it may be extracted by means
of a tenaculum or crooked probe.
    DIVISION  OF  THE PAROTID DUCT.
  When the parotid duct has been divided, either in
consequence of accidental injury, or in the performance
of an operation, the saliva Avhich it transmits instead of
going into the cavity of the mouth, passes over the
cheek, and thereby becomes an obstacle to the healing
of the Avound.
                   TREATMENT.
  The folloAving mode of treatment is recommended:
  When recent, adhesive plaster alone will sometimes
effect an union of the divided sides.—When of longer
standing, and the inferior extremity of the duct has be-
come obliterated, an artificial canal should be  effected,
by means of a perforation  made  obliquely  into the
mouth, Avith a small  curved trochar, beginning from
the  side  of the wound contiguous  to the divided ex-
tremity of the duct;  after which one end of  a bit of
catgut should be introduced at the artificial  opening,
and brought out at the mouth, while the other is passed 
132       ENLARGEMENT OF THE TONSILS.

a little Avay into the extremity of the natural duct, and
retained by adhesive plaster until the Avound is healed;
during which time the patient should live upon spoon-
meat, and make  as little motion as possible with his
lips and jaAVS.  Latta's System of Surgery.


     ENLARGEMENTS OF THE TONSILS.
  Enlargements of the tonsils may be  of two kinds :
  I. The common abscess occurring in cynanche ton-
sillaris.
  2. A chronic sAvelling, generally the consequence of
previous inflammation  of the gland  in a scrofulous
habit.
  They often become so large as to impede both respi-
ration and deglutition.
                   TREATMENT.
  Of the first species^-See  Cynanche Tonsillaris.
  Of the second species.—Extirpation by ligature.—If
the base of the tumor be smaller than  the apex,  a sin-
gle ligature is to be conveyed around  it, by means of a
forked probe, or an instrument invented for the purpose,
with  a ring  at its extremity.—When the form of the
tonsil happens to be conical, the needle invented by Mr.
Chesselden will become necessary.—A double ligature
being put into the eye near its point, it is to be pushed
through the centre  of the base of the tumor ;  after
which the ligature- should be laid hold of by a hook,
pulled forwards, and divided.—The instrument is then
to be withdrawn, and  the ligatures so tied, that each
part may surround one half of the tumor.—To render
the operation more distinct, one half of the thread may
be coloured, the other suffered  \q  remain white,—. 
        CONTRACTION OF THE CESOPHAGUS.       U5

When both tonsils are affected, in general one only
need be extirpated.—Should it become necessary to
extirpate both, the inflammatory symptoms ensuing
from the first operation should be allowed to subside,
before  an attempt is made to remove  the remaining
one.


      ENLARGEMENT OF THE UVULA.
  An enlargement of the uvula sometimes takes place,
and becomes so considerable as to give great uneasi-
ness, by impeding deglutition, irritating the throat, and
thereby causing cough, retching, and vomiting,
                   TREATMENT.
  When the enlargement is considerable,  strong as-
tringent gargles ;  as, a solution of alum in decoction of
bark, page  142.
  If it continue to increase in size, and become trouble-
some, extirpation by  ligature, applied as above men-
tioned ;  or by excision, performed by means of a curved
bistoury, Avhile the tumor is held by the tenaculum.
DISEASES OF THE ALIMENTARY CANAL,
   CONTRACTION OF THE CESOPHAGUS.
                    SYMPTOMS.
  The disease usually commences Avith a slight diffi-
culty  of deglutition,  especially  in  sAvalloAving solid
food ;—this  continues to increase for some months,
during which the patient is obliged to mince the solid
food Avhich he takes.—At length the passage becomes 
L54      CONTRACTION OF THE ffiSOPHAGUS,
so narrow, that not the smallest particle can pass ; but
after being for a short time detained at the contracted
part, it is rejected Avith a peculiar IioIIoav noise, and
with the  appearance  of  convulsion.—If  preventive
means are not taken,  the stricture becomes more and
more contracted, and at length so much so, as not even
to admit the passage of fluids.—Emaciation ensues, and
the patient is eventually  starved.—Ulceration  some-
times  takes place, attended Avith severe  lancinating
pain and hectic fever.
                      CAUSES.
  A morbid thickening of the mucous membrane of
the oesophagus,  induced by a previous state of inflam-
mation, or abrasion from Avhatever cause  ;—from the
SAvallowing of hot fluids, or from a Avound inflicted by
an extraneous body accidentally lodged in the part.
  Two cases are related by Dr. Helsham, in the Med-
ical  Journal, of a contracted state of the  oesophagus
from a protrusion of the spine.
                   TREATMENT.
  Dr.  Munckley recommends the use of mercury, first
in small doses, and  prevented by purges from affecting
the mouth;—in the more advanced stage of the disease,
so administered  as to  produce a gentle salivation.
  In the early stage, and before ulceration commences,
Mr. Wathen advises the daily introduction of a bougie
into the oesophagus, the size of which is to be gradually
increased, and the patient at the same time directed to
swalloAv pills, and  at  last boluses, of butter, boiled
fat, &c.
  This disease is treated successfully by Dr. Home by
the use of caustic, introduced in the same manner as
in strictures of the urethra.   Vide Strictures of the
urethra,        ' 
ULCERATION OF THE INTESTINES.       155
         SCIRRHUS OF THE PYLORUS.
                    SYMPTOMS.
  Long-continued symptoms of dyspepsia ;—sickness ;
—constant pain ;—.hard  circumscribed tumor  in the
epigastric region, at first insensible, afterwards painful
upon pressure ;—rejection of food after it has remained
in the stomach for the space of an hour—Dr.  Rahn, of
Zurich, Avhere the disease is very frequent, describes it
as often unattended by this symptom ;—obstinate cos-
tiveness ;—ulceration at  length takes place, Avhen the
pain becomes more intense, and is accompanied Avith a
sense of heat, referred to the throat;—the rejected food
is mixed Avith blood,—hectic fever ensues,—In some
instances dropsy,—great emaciation,—death.
                     DIAGNOSIS.
  From dyspepsia.—By the tumor in the region of the
pylorus ;—by the vomiting of blood ;—-by the  peculiar,
constant, and pungent pain ;—by the remarkable ema-
ciation.
                   TREATMENT.
  Before  ulceration commences.—Mercury, to excite a
slight salivation ;—blisters to the region of the part ;—
fomentations of cicuta ;—cicuta administered internal-
ly ;—the yolk of eggs ;—the daily use of purges.
  In  the ulcerated state.—Opium, administered both
externally by friction to the abdomen, and internally for
the purpose of allaying pain ;—cicuta.
       »

     ULCERATION OF THE INTESTINES.
   This produces symptoms of dysentery, and is treated
by physicians. 
4o6
IMPERFORATE ANUS.
     SCIRRHOUS CONTRACTION OF THE
                     RECTUM.
   This is a disease similar in its nature to the contrac-
 tion of the oesophagus already described.
                      SYMPTOMS.
   Sense of pain in the part;—obstinate costiveness ;—
 the faeces much  contracted  in  size ;—the  anus con-
 stantly in  a moistened  state, from the presence of a
 slimy mucus ;—frequent  tenesmus ;—constant irrita-
 tion and uneasiness doAvn the thighs ;—if ulceration
 takes place, the pain becomes peculiarly pungent and
 lancinating,—blood or  a  sanious fluid  is  often dis-
 charged by  stool,—great  emaciation  ensues,'—hectic
 fever,—death.
                    TREATMENT.
   In the early stage, mercury, to  excite a slight saliva-
 tion ;—if the stricture be Avithin reach, recourse must
 be had to  the frequent introduction  of a bougie of a
 large size  into  the  rectum,  or retaining it there con-
 stantly, by means of  tapes connected Avith a bandage
 passed around the loins ;—frequent dilatation by the
 use of the  speculum ;—the repeated  use of copious
 emollient clysters.
   In the ulcerated state, the internal and topical use of
hyoscyamus, aconite, cicuta, and opium.
             IMPERFORATE ANUS.
  The anus  is not unfrequently found imperforate at
birth ; and in some instances  it is closed simply by a
thin membrane, in which case the meconium  may be
distinctly felt a day or two after birth, and in a manner
seen shining through it. 
ULCER IN THE LARYNX.
1-5?
                    TREATMENT,
   A slight puncture Avith a lancet, and the subsequent
 introduction of a bougie, will in every case be proper.
 But more commonly the imperforate anus is a mel-
 ancholy occurrence, and seldom admits of a remedy,
 the gut often terminating in a cul de sac, so high up as
 not to be reached.  In other instances, however, it may
 be relieved by an  operation.  This  consists in first
 making a longitudinal incision in the  natural situation
 of the anus (the operation being postponed as long as
 it safely can, that the depending part of the boAvel may
be distended, and pushed as  Ioav down  as  possible);
and afterAvards passing up a small trochar, in the usual
direction of the boAvel, until u"shrill have entered the
extremity of the gut, and the meconium  flow from the
canula.  A piece of bougie  is aftenvards to be intro-
duced daily, until the edges of the sore  become suffi-
ciently callous to prevent a reunion taking place.


DISEASES OF THE RESPIRATORY ORGANS
           ULCER IN THE LARYNX,
                    SYMPTOMS.
  Remarkable hoarseness ;—perpetual irritation at the
top of the Avindpipe, which nothing will relieve ;—there
is no pain nor soreness  in the lungs.—It commences
in some Avho are otherwise in perfect health,  and often
continues for years before it brings them to extremi-
ties ;—the cough at length expels real  pus, which in-
creases more and more ;—a destruction of the powers
                       P 
158           SUSPENDED ANIMATION.
 of Aroice ensues,—the patient becomes hectic, and dies.
 Wathen, Memoirs of the Medical Society.
                      CAUSES.
   Unknown.—It has occurred as a consequence of the
 venereal poison, and may probably be induced by in-
 flammation or irritation of Avhatever kind.
                    TREATMENT.
   Blisters, issues, or setons, in the neighborhood of the
 part ;—frequently inhaling the steam of hot Avater im-
 pregnated Avith cicuta;—opium administered in the
 form of linctus—If the disease arise from a syphilitic
 affection,  mercury ;—inhaling the steam of hot water
 impregnated with nitric acid ;—decoction of the woods,
 Sec.  Vide Syphilis.*^* >


        OF SUSPENDED ANIMATION.
   No subject has given rise to a greater diversity of
 opinion than the nature  of the immediate  cause of
 death produced by droAvning, hanging, Sec.—From the
late discoveries in chemistry it appears, that the cessa-
 tion of the poAvers of life arises from the suspension of
 respiration merely  ;  and  thereby the interruption of
 that process, by  which the blood is meliorated, or un-
 dergoes a certain change in its passage through the
lungs.   Vide Goodwin on the Connexion of Life with
 Respiration ; Curry, Observations on apparent Death,
 iS?c.:  Coleman on suspended Animation.
                   TREATMENT.
   The patient is as  soon as possible to be conveyed in-
 to a warm room, and, if it can be speedily procured, im-
 mersed in a warm bath ;—immediate and copious evac-
 uation of blood from the arm ;—after which extensive 
SUSPENDED  ANIMATION.
159
and continued friction should  be practised Avith  salt or
Avarm flannels;— stimulating fluids, as brandy, or spir-
itus ammoniae compositus, diluted, are to be poured in-
to the stomach,—and attempts to inflate the lungs are
to be made, either by means of the tube passed into the
larynx as directed by the Humane Society,  or by the
common bellows introduced at the mouth ; while this,
together with the aperture into the nose, is securely
closed.—Should these means prove unsuccessful, re-
course must  be had to the operation of—
                  BRONCHOTOMY.
  The patient should be in the sitting posture, the bo*
dy bent a little forwards, the head turned back.
  The first incision should be through the integuments,
midAvay between the  sternum and the cricoid cartilage:
the arteries of the thyroid gland will by this means be
avoided.—The trachea being thus exposed, ah opening
must be made Avith  the point of a lancet, of sufficient
extent to admit of the introduction of the canula.—This
is now to be passed into the artificial opening, and to be
secured in its situation by means of a bandage, previous-
ly  connected Avith it,  passed around  the  neck.—Its
mouth should be covered Avith a piece of thin gauze, to
prevent the admission of extraneous matter ; and Avhen
the causes Avhich endangered suffocation have been re-
moved, it is  to be AvithdraAvn, and the wound healed as
 an accidental Avound of the part.


                              4
0-J\*  V.*   *% ♦ .  ««**& oStrV-£fc*»*  **$V 3 
160
DISEASES OF THE CHEST.
    VOMICA,  OR ABSCESS OF  THE  LUNGS
                     SYMPTOMS
   After preceding inflammation of the lungs, severe
 rigors,—the pain before diffused, noAV becoming confin-
 ed to a circumscribed spot;—great heat and restless-
 ness ;—sensation of heat in the throat,—cough,—quick
 pulse,—fiery red tongue,—debility of the loAver extrem-
 ities.—The abscess thus "formed,  either opens into the
 bronchia, or into the cavity of the pleura —In the first
 case the matter is expectorated, and thereby the symp-
 toms are greatly  relieved, but the cough and expecto-
 ration long remain, and the disease either terminates in.
 phthisis, or the cavity is  gradually filled up by granu-
 lations.—Of the latter, empyema, or sudden suffocation,
 are the consequences.
                   TREATMENT.
   Consult medical works  on Pneumonia, and Phthisis
 'Pulmonalis


                   EMPYEMA.
                    SYMPTOMS.
   Sudden cessation of the symptoms of vomica above
mentioned, or of  pneumonia, followed by vast oppres-
sion and sense of  weight in the chest;—an inability to
lie on the affected sidejt-frequent and severe rigors ;__
cold clammy SAveats^-small oppressed pulse;—dark
flush upon the countenance ;—an enlargement, or soft
cedematous fulness, of the affected side;—the undula-
tion of a fluid sometimes becomes sensible ;—when the
 
       CQLLECTIONS OF BLOOD IN THE CHEST.    161

effusion happens to be on the left side of the chest, the
palpitation of the heart becomes lost or imperceptible.
                   TREATMENT.
  The .operation of Paracentesis of the Thorax.  See
page 162.

                      — ~*                  ,'

 COLLECTIONS OF BLOOD IN THE CHEST.
                      CAUSES.
  Erosion of vessels in consequence of ulcerations of
the lungs;—inflammatory congestion of the vessels of
the lungs ;—external injury ;—violent exertion of the
organs of respiration;—immoderate exercise in run-
ning, leaping, &c.
              DIAGNOSTIC  SYMPTOMS.
  When consequent upon a previous disease  of the
lungs, the  symptoms so  exactly resemble those pro-
duced by effusion of matter, that it will  be difficult or
impossible to distinguish  the one disease from the oth-
er, until an opening has been made into the thorax, for
the purpose of evacuating the collected fluid.—In gen-
eral the effusion of blood takes place at the height of
the disease, and, if considerable, is instantly followed by
syncope, or sense of suffocation.—The symptoms pro-
duced by the effusion of  matter are more  gradual, and
less severe.
  When the consequence of active haemorrhagy from
the vessels of the lungs, the nature of the  disease may
in general be ascertained  by a previous sense of heat in
the chest, confined to a particular spot;—by the pulse
having a peculiar jerk or salient feel;—by the counte-
nance of the patient.
                        PS 
.162
HYDROTHORAX,
  If the aboAre symptoms, of empyema, are the imme-
diate effect of external violence, or over-exertion,  StcV
no further diagnostic mark is required.
                   TREATMENT.            . /»
  The Paracentesis of the Thorax.  Sec below.
            COLLECTIONS OF AIR.
               DIAGNOSTIC SYMPTOMS.
   Sudden anxiety and difficulty of breathing, sometimes
amounting to  so high a degree  as to threaten  instant
suffocation.—It  is distinguished from the tAvo preced-
ing diseases by the absence of fever,—by being unat-
tended Avith rigors,—by the anxiety and oppression, aris-
ing rather  from a  sense of constriction  than  from the
dull weight above described,—by the emphysematous
SAvelling of the integuments, which in general folloAVS.-
an effusion of air into the chest.


                HYDROTHORAX.
  The symptoms and treatment of this disease are laid
down by writers on medicine.  The surgeon is occa-
sionally consulted to evacuate the water.  The  opera*
tion is called
          PARACENTESIS  OF THE THORAX.
  The patient being laid in a recumbent posture, with
the shoulders  rather elevated,, and the body inclined to
the affected side, an incision is to be made between the
sixth  and seventh rib, near to the inferior of the two,
and almost midway betAveen the spine and  the sternum ;
previously, however, to which, the integuments  should
be so  drawn up with the left hand, that, when  returned 
          PARACENTESIS OF THE ABDOMEN.      T6.3

 to their original situation, they may form a valve over
 the opening  aftenvards  made.—The pleura being ex-
 posed,  a small aperture is to be cautiously made into
 the chest, through Avhich a  silver canula of a proper
 size is  to be  introduced, and by this means the fluid
 gradually evacuated;  not all at once, but  at several
 successive times; in the intervals betAveen  Avhich the
 orifice of the canula should be closed with a compress
 of lint  or small cork,  and secured in its situation by
 means of tapes or strings connected with a napkin and
 scapulary bandage.
  After the collected matter, or other fluid, has been
 wholly  evacuated, the canula is to be  AvithdraAvn, and
 the Avound covered Avith the flap of integument pre-
 viously formed.   Union by the first intention should be
 prevented, lest the fluid again accumulate, and a repe-
tition  of the operation become necessary.—If coagu-
lated blood be contained  in the chest,  it has been re--
 commended to employ injections of tepid water.
     PARACENTESIS OF THE ABDOMEN.
  The operation becomes necessary when the pressure
of the Avater contained within the cavity of the perito-
neum is  so  great as to impede the function of respira-1
tion.
  During the operation, the patient should be in a sit-
ting posture, with a vessel for the reception of the flu-
id placed betAveen his legs, and his body encircled with
a long bandage or towel, the ends  of which are  to be
held by tAvo assistants.—These preparations being ad-
justed, and the patient having been directed to void his
urine, or a catheter having been introduced for the pvr/« 
164
CANCER OF THE BREAST.
pose of draAving it off, a small incision is to be  made,
Avith a common lancet, about an inch beloAV the umbili-
cus ; after Avhich a lancet-pointed trochar is to be push-
ed fonvards, till, from no longer meeting  Avith  resist-
ance to its passage, it is ascertained to be within the cav-
ity  of the abdomen ;—the stilette is then to be Avith-
drawn, and as the fluid is evacuated, the bandage, pre-
viously fixed round the abdomen, is to be draAvn tighter
and tighter, to prevent the effects of a sudden  removal
of the accustomed pressure.
  After the Avhole  of the Avater has thus escaped, the
wound is to be closed by adhesive plaster, and the body
to be encircled with a roller of flannel, Avhich should be
suffered to remain for some days after the operation.
  It is recommended by Dr. Sims, in the Memoirs of
the London Medical Society, to introduce the trochar at
the umbilicus.   In this case the first incision will be
unnecessary.


         DISEASES OF THE BREAST.
               INFLAMMATION.
  The breast is  subject  to common  inflammation,
which is called Mastodynia.   This,  as  Avell as its
terminations, are to be treated as directed under the
head of inflammation.
                  CANCER.
                  SYMPTOMS.
The disease  makes  its appearance  with a small, 
               DANGER OF THE BREAST.           1-6J

 Irard, circumscribed knot, distinctly moveable, beneath
 the integuments of the breasts—As it increases in size,
 it  is attended with lancinating pain, the veins of the
 skin become varicose, and the adhesions betAveen the
 integuments and the tumor often take place, creating
 the resemblance of cicatrices, arising from previous
 wound or ulceration.—The tumor now ceases to be
 moveable, becomes completely fixed in the substance
 of the breast, and a hard line  is  often  felt, extending
 into the axilla, Avhere  a  small gland at the edge of the
 pectoral muscle is found enlarged.—At length a part
 of the tumor becomes  soft, the presence of a fluid is
 perceptible, ulceration takes place, and an excoriating
 ichorous matter is discharged at the opening.—The
 pain is now excruciating, and  of a pungent nature.—
 The ulcer puts  on the appearance  already described
 (vide Cancerous Ulcer), and often shoots forth a dark-
 coloured fetid fungus of considerable size.—A fatal
 hectic puts a period to the sufferings of the patient.
                      CAUSES.
  The usual exciting  causes are,  injury of the  part
 from external  violence,—inflammation  hoAvever in-
 duced.
                    PROGNOSIS.
  The circumstances Avhich lead to a prediction of the
 favourable  event of an operation are, unimpaired con-
 stitution  of the  patient;—the tumor still remaining
 moveable beneath the integuments ;—the glands of the
 axilla as yet unaffected ;—there being no cicatrices on
 the skin.
                    TREATMENT.
  It is recommended  by Mr.  Fearon, upon the sup-
 position cf cancer being induced by a previous state qf
inflammation, to  have immediate  recourse to local 
166          CANCER OF THE BREAST.
bleeding, gentle laxatives, and the antiphlogistic regi-
men, upon the first appearance of a disease of the breast
after a suppression of the menses.
  The use of cicuta, as a remedy for cancer, has been
perhaps too  higly extolled.—The  extract is  usually
employed, beginning, with tAvo grains three times a day,
and gradually increasing the dose until it arrive at ten
grains or more, unless it disagree.
  Mercury, in the early stage of- the disease, has in
some instances been successful—Plummer's  pill,  or
hydrargyrus  muriatus united Avith decoctum sarsapa-
rillae compositum.
  Arsenic ;—from the concurrent testimony of many
respectable authorities, no doubt can be entertained of
its having been, in some instances,  successful.  Vide
Justamond on Cancer ;  Rush, fy American Transac-
tions ; Simmons, Medical Journal.—FoAvler's arsenical
solution will be the most proper form for its adminis-
tration ; the dose is from four to six drops three times
a clay.
  Dr. Crawford recommends  the  use of a saturated
solution of muriated barytes,  from four  to ten drops
twice a day.
  The internal use of the plant called  gaiium  aperine,
or goose-grass, is proposed by Dr. Saunders, and some
cases of apparent cancer haAre given Avay to its use.
  The ferrum ammoniacale Avas successfully employed
by Mr. Justamond ; as also the external use of a lotion,
in Avhich the tinctura ferri muriati, and  spirit of Avine,
were the chief ingredients—From three to ten grains,
of the ferrum ammoniacale are to be given twice or
three  times a day.
   After a short continuance of the use of internal  rem- 
              CANCER OF THE BREAST.           167

cdics Avithout success, it will ahvays  be advisable to
have recourse to the only effectual mode of cure ;  i. e.
extirpation of the tumor.—For this purpose, corrosive
plaster of different kinds have  been sometimes em-
ployed Avith the desired effect.
  Mr. Justamond used  a plaster formed from yelloAV
orpimcnt, preA-iously causing ulceration of the integu-
ments by the application of lunar  caustic ; and by Dr.
Moseley, an adhesive plaster, strewed with corrosive
sublimate, was employed Avith success in several cases.
  From the injurious effects of such applications upon
the constitution, it will be prudent to avoid such mode
of treatment, and Avhile the disease is yet in its early
state, to  perform the folloAving operation :
                  THE OPERATION.
  The necessary preparations being adjusted, a semi-
circular incision is to be made across the upper portion
of the breast, above the nipple ;  after which the integ-
uments  are  to be cautiously dissected aAvay from the
diseased mamma, beginning at the upper side of the
Avound, and proceeding to detach the tumor until the
mammary artery has been divided ; Avhen this should
be secured by ligature, before any further progress is
made in  the operation.—The integuments of the loAver
portion  of the breast are iioav in like  manner to be
separated from their connexions, as is afterwards the
gland itself from the  subjacent  pectoral muscle.—
When the  Avhole glandular part  has  been thus com-
pletely removed, the arteries are to be secured by
ligature, the integuments brought together, and their
divided  edges retained  in contact by means of  the in-
terrupted suture, or by straps of adhesive plaster ; the
part covered with a compress of  soft  linen or lint, and 
168
HYDARTHRtS.
the dressings secured in their  situation by the napkin
and scapulary bandage ;  Avith Avhich a moderate pres-
sure should be made.—Should there be any cicatrices
of the skin, that part of the integument in Avhich they
are seated should, during the operation,  be  removed.
If a gland on the axilla has become enlarged, this, to-
gether Avith all  the intermediate substance, ought to
be extirpated.
DISEASES OF JOINTS.
                 HYDARTHRUS.
   A dropsical accumulation Avithin the capsular liga-
ment of a joint; generally of the knee-joint.
                     DIAGNOSIS.
   Preternatural swelling  of the joint, without discol-
ouration ;—'the  hand placed on one side of the joint,
while a slight percussion  is made against the opposite,
Avill receive an impression similar to that experienced,
Avhen making the same experiment, to ascertain the
presence  of a dropsy  of the  abdomen.—Continued
pressure upon one side will, by depressing that, occa-
sion a considerable and obvious elevation of the other.
—The fluid, in  passing from  side to side under the
patella, raises this above its usual level.
                     CAUSES.
  The hydropic  diathesis;—d.-.-bility, however induced;
—the debility consequent  upon low fevers ;—rheuma-
tism ;—scrofula  ;—syphilis. 
        ■COLLECTIONS OF BLOOD IN THE JOINTS.    169

                    TRKATMtJIT.
   The repeated application of blisters, kept open by
 the use of unguentum cantharidis;—friction;—elec-
 tricity ;—mercury,  applied  locally to the joint, and
 likewise  administered  internally ;—cold affusion ;  a
 convenient mode of applying cold water in this Avay is,
 to pour it, in a continued stream, from the spout of a
 teakettle,  held  at a considerable distance above the
 knee of the patient ;—the discuticnt applications re-
 commended for the early stage of Avhite sAvelling ;
 which see at page 171,


                   GANGLION
  Vide Tumors?  '


           COLLECTIONS OF BLOOD.
                     DIAGNOSIS,
  A collection  of blood is known to have taken place
within the joint, by  the  SAvelling Avhich is produced
coming on suddenly, and being the immediate conse-
quence of an injury Avhich the part has sustained ;  and
by the colour of the tumor, Avhich, Avhen the capsular
ligament has been broken, is  dark and livid.
                       CAUSE.
  Injury done to the part from  external violence,
                    TREATMENT.
  The means above  recommended  for procuring ab-
sorption  are  first to be employed;  and if these prove
ineffectual, recourse  must be  had  to an operation for
evacuating the effused fluid.
                        Q 
170
WHITE SAVELLING.
   The best mode of performing this is as folloAvs :—t
 The integuments are first to be tightly draAvn up above
 the  part chosen for the incision, so that after the evac-
 uation of the fluid, they may,  upon being  let down,
 form a Aalvc,  and effectually prevent the  admission of
 air, Avhile a small opening is cautiously made through
 the capsular ligament.—The  blood  being eAracuated,
 adhesiAre straps are to be applied to  procure union by
 the first intention ; and the patient should  be put upon
 a strict antiphlogistic regimen, to obviate the  effects of
 the inflammation,  which so generally succeeds  open-
 ings into the large joints.


          COLLECTIONS OF MATTER.
                    DIAGNOSIS.
  Tumors of joints,  formed by collections of matter,
are distinguished  from the two former  diseases, by
having been  preceded by much pain and inflammation,
of Avhich  they are the consequence.—The  matter is
sometimes external  to  the capsular ligament ;  some-
times it is contauied within it.—The former case is a
more frequent sequel of rheumatic inflammation than
has been generally supposed.
                   TREATMENT.
  A simple incision, if the fluid be above the ligament;
—the operation above described, if beneath it.
              WHITE SWELLING.
                    SYMPTOMS.
  In the knee-joint.—Pain in the inside of the patella,
which is often deep seated in the joint, unattended with 
AVHITE SAVELLING.
tfl
external  swelling or inflammation, and is not exaspe-
rated by pressure__Sometimes it comes on gradually ;
at others it becomes suddenly  violent, and is confined
to  a limited spot, apparently in the capsular  ligament
of  the joint—The swelling, at first inconsiderable,
gradually increases in size, and  the pain becomes more
acute ;—a fluctuation  is perceptible, and frequently
there  is an enlargement of one or both of the bursas
mucosae.—Ulceration at length takes  place, though
sometimes not until after many months have expired,
and matter is discharged ;  most frequently at several
different openings, the principal of Avhich is at the lower
part of the joint.—A hectic fever arises, which often
destroys  the  patient, if the sense of irritation be not
removed by an operation.—Either this  or anchylosis
Avill be the termination of the disease, after suppuration
has taken place.
                      CAUSES.
  Remote.—Scrofula.
  Exciting.—Injury of any kind, or an attack of inflam-
mation.
                   TREATMENT.
            f  i. To remove those circumstances of
                   constitution Avhich  predispose to
                   the disease.
Indications.^  ii. To prevent suppuration in the early
                   stage.
             in. When suppuration has taken place,
                   to obviate its fatal effects.
  Internally.
  The means recommended for the cure of scrofula in
medical Avorks.
  Locally.
  In the early stage,—The application of leeches, fo- 
17_               WHITE SAVELLING.
mentations, and poultices ;—cataplasm of the quercus
marinus.   See Scrofulous Ulcer.0
  Repeated blisters, or blisters kept open by the ap-
plication of the ceratum cantharidis, or sabinae.
  Caustic issues have been attended with great benefit.
  Refrigerant and astringent lotions ;  of ammonia mu-
riata, of alum, of zincum vitriolatum.
  The application of stimuli, to excite superficial irri-
tation ;  as, mercurial friction, the linimentum ammo-
niae.
  Mr. Russel recommends  a paste made of gummi
ammoniacum and  acetum  scillae;  or a  liniment of
oleum terebinthinae, with hog's lard.
R. Gummi aromoniaci ?ij.     Take Gum  ammoniac 2ij.
   Aceti scillae q. s.             Vinegar of squills q. s.
The ammoniacum is to be reduced  to a fine powder,
  and enough Amegar of squills to be added to form it
  into a consistency to be easily spread on leather.
  This  Avas  often used AArith  success by the late Mr.
Cruick shank.
 , The ammoniacal plaster  with cicuta is also bene-
ficial.
 EMPIiASTRUM AMMONIACI    AMMONIAC PLASTER AVITH
      CUM CICUTA.                  CICUTA.
       Pharm. Chir.
H, Ammoniaci gummi-resinae  Take Gum  ammoniac ?iij.

   Succi cicutae spissati JiJ-     Extract  of cicuta Zij.
   Aqux lithargyri acetatse Jj.     Solution of acetite of lead 3J.
The ammoniac is to be dissolved in a sufficient quan-
  tity of vinegar of squills ; after which the remaining
  ingredients are to be added, and the whole boiled
  sloAvly to the  consistence of a plaster.
  Lime, formed into a cataplasm with meal and lard'.
l$ath Infirmary.. 
SUBSTANCES IN THE CAPSULAR LIGAMENTS.   I7v>
  The volatile plaster of Dr. Kirkland :
R. Saponis irij.              Take Soap ?ij.
   Emplastri lithargyri -ss.      Oxyd of lead plaster ?ss.
   Ammonix muriutse ^j        Muriate of ammonia "Zf\.
The two former  to  be melted together,  and,  when
  nearly cold, the ammonia muriata, in fine poAvder, to
be stirred in.
  Friction Avith brine.
  An ointment of emetic tartar.
It. Antimonii tartarisati Jj.     Take Tartrite of antimony Ji.
   Unguenti adipis suillae rj-     Ointment of hog's lard 5i.
These are to be rubbed Avell together, so as to forma
  smooth liniment, of which one drachm or more is to
  be rubbed on the knee for ten minutes.
  Oxygen gas;—a  successful case  related by Dr.
Beddoes.
  In the ulcerated state.—Nutritive  diet ;—by tonics,
and by all the means adapted to the treatment of hectic
fever from other causes ; and if these prove ineffectual,
recourse must be had to an operation for the removal
ef the limb.
   CARTILAGINOUS AND FUNGOUS SUB-
     STANCES WITHIN THE CAPSULAR
                   LIGAMENTS.
  Small  bodies are not unfrequently formed beneath
the capsular ligaments of joints, AAdiich impede their
motion, and  often  occasion  much pain.—They are of
tAvo kinds :
  i.  Hard and cartilaginous, and loose  in the cavity flf
the joint.
                       Q3 
*t 14,  SUBSTANCES IN THE CAPSULAR LIGAMENTS,

  2. Soft, and similar to bursae mucosae, and generally
attached to the cartilages.
  They vary in  size,  being sometimes  as  large  as
horse-beans,  and  at others there are several contained
in the same joint.
  The first species occasion sudden and violent attacks
of pain, upon any  motion of the limb, or upon change of
posture,  Avhich go off as suddenly upon a repetition of
the same cause that induced them.—The pain arising
from the second is constant, but less acute.
                      CAUSES.
  Mr. Hunter attributed the origin of these substances
to a portion of blood, effused by some injury Avhich the
joint might have sustained, and becoming organized by
the action of contiguous parts.
  Mr. Russel, on  Diseases of the Joints, supposes them
to arise from an inspissation of synovia.
                    TREATMENT.
  Many cases are related by Mr. Hey, in his Observa-
tions in  Surgery, which Avere successfully  treated by
the application of bandages, and by the constant use of
a tight-laced knee-cap.
  Should this  mode  prove  ineffectual,  the  body, if
loose, may be. removed by operation. This is directed
by  Mr. Home, in the Transactions of the Society for
 the Improvement of Medicine and Surgery, to be per-
 formed in the knee in  the folloAving manner :
                    OPERATION.
   The limb being extended, and in a horizontal posi-
 tion, the loose cartilages are to be pushed to the upper
 and inner side of the joint, so that the vastus internus
 muscle only may be divided ; and being secured in that
 Situation, the skin of  the part where the incision is. to 
            DISEASE OF THE HIP-JOINT.         Ifji

be made should be so draAvn up, that the wound in the
parts underneath may not aftenvards correspond Avith
that through the integuments.—The loose body is hoav
to be  exposed, by cutting immediately upon it, and at-
tempts are to be made to press it through the opening ;
—should  these be  unsuccessful, a tenaculum, or the
broad end of an eyed probe, may be passed under it,
and by  this means it may be lifted out.—The Avound
should be carefully healed by the first intention ;  and,
to prevent inflammation, the limb sliould be kept in the
extended  position,  and  the  patient put upon the anti-
phlogistic regimen.


      THE DISEASE OF THE HIP-JOINT.
                     SYMPTOMS.
   A degree of lameness scarcely Ansible, often ascribed
 to indolence, or to the indulgence of aAvkward habits;"
 —after the expiration of a shorter  or longer time, the
 leg and thigh of the affected side appear lessened in
 circumference, and the limb is evidently elongated ; so
 that  in standing erect, Avhile the sound limb is slowly
 extended, the  diseased is separated from the body, or
 the knee is bent to a considerable angle —The nates,
 upon inspection, appear flattened ;—pain in the region
 of the  part, in some cases obtuse and deep-seated, in
 others  more  acute ; pain in the knee, often so excru-
 ciating as to occasion the most agonizing screams ;—■
 the difficulty  of walking increases ;  is  particularly
 obvious in  the morning, becomes less so as  the day
 advances, but returns   again in an increased degree
 towards  night.—Upon  any quick  exertion the patient
 is apt to fall__In a recumbent  posture,  the diseased 
 176          DISEASE OF THE HIP-JOINT.

 thigh is bent forward, and  every  attempt to alter its
 position is attended Avith great pain.—The joint be-
 comes tender to the touch, and the lymphatic glands at
 the groin are enlarged ;—the lameness becomes more
 and more obvious ;—the pain more  sensible, and the
 limb is  considerably reduced in size ;—a sIoav hectic
 fever arises, Avith great prostration of strength.
  At length  the  limb, before elongated, shortens ;  a
 circumstance Avhich announces an ensuing suppuration.
 The tenderness and SAvelling increase, the patient is
 incapable of supporting himself, unless by crutches.—.
 The abscess at length breaks, and discharges the curdly
matter  peculiar to  scrofula.—The patient iioav grows
languid, the  symptoms of hectic  fever become more
violent, he loses his  appetite,  is gradually emaciated,
colliquative discharges come on, and not unfrequently
the disease terminates fatally.—When a recovery takes
place after the disease has so far advanced, it is effected
by an anchylosis of the joint.
                      CAUSE.
  Scrofula.
                    DIAGNOSIS.
  The pathognomonic symptoms are, the pain in the
hip ;—the elongation and subsequent shortening of the
limb ;—the difficulty of turning the leg  imvards, when
in a recumbent posture ;—the flattened  appearance of
the nates ;—the excruciating pain in the  knee-joint.
                   TREATMENT.
  Mr. Ford directs the folloAving :
  Topical bleeding,  where there is much pain and  in-
flammation ;—the warm bath ;—blisters ;—a caustic
issue inserted  in the hollow behind the  great trochan-
ter ; it  should  be about an inch in lengtli, and half  m 
PSOAS ABSCESS.               17/
inch in  breadth, and made by rubbing on the caustic
until  the  skin change  from its  natural  colour  to  a
brownish hue.  Vide Ford on the Diseases of the Hip-
Joint.
  Great attention  should be paid to the state of the
constitution, as in all other  diseases arising from the
same source.


                PSOAS ABSCESS.
                    SYMPTOMS.
  Previous to the appearance of any other symptom,
the patient long feels an unaccountable sense of Aveak-
ness  across the loins,  accompanied by an obtuse, yet
distressing pain ;  and often has recourse  for relief, to
the usual  remedies recommended for lumbago or ne-
phritis.—Pain  at  length diminishes, and appears to
change  its seat from the loins to the  thigh and hip,
becomes lancinating, and follows the course of the an-
terior crural, or sciatic nerves.   This  change is fol-
loAved by an  enlargement of the glands of the groin,
and not unfrequently by a total loss of the use of the
loAver extremities.—At length a soft fluctuating tu-
mor,  unaccompanied by pain or  any discolouration of
the integuments,  is perceived immediately beneath
Poupart's ligament, or by the side of the anus, under
the glutei muscles, which increases until it has attained
a large  size ;  often extending a considerable Avay  doAvn
the thigh, under its fascial aponeurosis.—If preventive
 means are not taken, Ulceration ensues, a  severe hectic
fever arises, and a fatal termination is put to the disease.
                       CAUSES.
   Scrofula -;—injury done  to  the back and  loins  by 
173
DISLOCATION.
 severe twists, blows, Sec.;—sudden exposure to cold
 after  severe  exercise ;   particularly  in  scrofulous
 habits.
                     DIAGNOSIS.
   Upon the first  appearance of the  tumor beneath
 Poupart's ligament, it possesses  so many of  the char-
 acteristics of hernia as to be with difficulty distinguished
 from it.  See Hernia.—The pain and Aveakness in the
 loins, and the fluctuation, are distinguishing symptoms.
                    TREATMENT.
   Repeated discharges of the matter through a valvu-
 lar opening made by means of a lancet, or small lancet-
 pointed trochar, introduced  into the tumor after having
 previously draAvn the  integuments upAvards, in such
 manner that the orifice shall be  completely closed on
 their returning to their natural situation ; during which
 time the medical treatment  proper for scrofula  should
 be assiduously  employed,—bark  Avith alkalies,—nutri-
 ent diet,—preparations of iron, &c. &c.  See  medical
 writings on 5t-r«/"„/_.—Should there be much sympa-
 thetic fever,—digitalis,—cicuta.


                 DISLOCATION
  Is the secession of a bone  of a moveable articulation
from its natural cavitv.
                      CAUSE.
  Accidental violence. 
         DISLOCATION OF THE LOAVER JAAV.      179

               GENERAL TREATMENT.
            f  i. To reduce the protruded bone to its
                    original place.
Indications.^  n. To retain it in that situation.
            j in. To obviate any attendant or conse-
                    quent morbid symptom.


             OF THE LOWER JAW.
  This  luxation can  only take place in one direction,
i. e. fomvards and doAvnwards.
                     DIAGNOSIS.
  When both  sides are luxated, the mouth is widely
opened, the  chin draAvn forwards tOAvards the breast,
and the speech is inarticulate.—When a dislocation has
happened on one side only, the mouth is distorted, and
widest on the sound angle of the jaw, which is drawn
a little towards the contrary side, and a small hollow
may be  perceived behind the displaced condyle.
                   TREATMENT.
  The thumbs of the operator, secured Avith a covering
of linen  or leather, are to be introduced into the mouth,
and  pushed as  far as possible between the jaAvs, Avhile
the fingers should at the same time be applied  to each
angle of the outside.
  Attempts must hoav be made to move the bone from
its situation, by bringing it first a little forwards, and
then pressing it forcibly downwards ; when it will gen-
erally slip into  its place without further trouble.
  The patient should for some time avoid much speak-
ing,  or the deglutition of hard substances. 
no
DISLOCATION OF THE STINE.
                 OF THE HEAD.
                    DIAGNOSIS.
   The head, Avhen luxated, generally falls forwards on
the breast__There is  an instant deprivation of sense
and motion, and if a reduction be not speedily effected,
death must ensue.
                   TREATMENT.
   The head  should gradually be draAvn up, whilst the
shoulders a'-e pressed oowmvards by an assistant, until
the bones are brought into their place ; when the pa-
tient, if the injury has not been fatal, gradually recovers
his senses.
   The head should long be retained in an elevated po-
sition by instruments contrived for that purpose ;  and
should symptoms of fever or irritation come on after
the accident, it will be necessary to bleed, and use other
appropriate means for its reduction.
                 OF THE SPINE.
                     DIAGNOSIS.
  The symptoms vary as  the  luxation happens to be
high up, or at the inferior part of the vertebral column.
—There is a total paralysis of all the parts beneath the
place Avhere the accident  has happened ;—there  is
either a  suppression  of  urine  and faeces, or  they arc
discharged involuntarily.
                   TREATMENT.
  The attempts for reduction will vary with the direc-
tion of the dislocation.—It is recommended to lay the
patient on his face over a cylindrical body of a proper
size, and in this position  to endeavour to reduce the 
v         DISLOCATION OF THE HUMERUS.        18!

bones to their proper situation, by slowly bending the
body fonvards or to one side.
              OF THE CLAVICLE.
  The clavicle may be dislocated either at its junction
with the scapula, or Avith the sternum.
                    DIAGNOSIS.
  It is discerned by the unnatural tumor of the part;
—by the  shoulder falling  fonvards ;—by the Avant of
mobility, and by tracing the bone along its extent.
                   TREATMENT.
  The arms  and shoulders of the  patient are to be
firmly drawn backwards, by an assistant, whilst the op-
erator  replaces the protruded end of the bone;—the
stellate bandage (vide Fracture of the Clavicle j \% noAV
to be applied, and the arm supported by a sling.
             OF THE  HUMERUS.
  The humerus may be dislocated in three different di*
rections,
        i. Downwards into the axilla.
        n. Fonvards under the clavicle.
       in. Back\vards on the scapula.
                    DIAGNOSIS.
  In a dislocation of the os humeri, the usual rounded
appearance of the shoulder is lost, and the lower edge
of the pectoral muscle is drawn into a straight line ;—,
there is  an inability to raise the arm, and when forcibly
raised, an  angle is perceptible in the middle, having the
                        R 
 182       DISLOCATION OF THE HUMERUS.

 appearance of a fracture at that part.—Upon feeling for
 the head of the bone, an unusual vacuity is perceived
 under the acromion of the scapula.
   Downwards.—The arm of that  side is longer than
 the other, and hangs ciose to the body ;—the head of
 the humerus may  be ft  it in the ami-pit.
   Forward.-:.—The arm is separated from the body in
 an angle of several degrees ;—it is  considerably short-
 er, and upon rotatory motion, the head of the bone is
 felt lying under the middle of the clavicle.
   Backwards.—Tne  tumor is alone a sufficient diag-
 nostic.
                   TREATMENT.
   A bandage,  or strong belt, is to be passed under  the
 axilla  of the injured side, and carried over the opposite
 shoulder ;—by this means, Avhen extension is made, the
"scapula will be prevented from moving.—A second belt
 is to be applied just above the elboAV of  the dislocated
 arm.—By the latter of these a gradual extension must
 iioav be made,  in a direction obliquely dowmvards and
 outAvards ;—the body being at the same time kept im-
 moveably fixed, by assistants  drawing  the  former belt
 in an opposite direction.—After this extension has been
 kept  up for a short time, during  which it should be
 gradually increased in  force, the operator is with one
 hand to draw or push back the scapula, with the other
 to direct the bone  into its cavity.
   When the  luxation has been of long standing, or in
 cases  where the head of the bone is protruded far for-
 wards under the pectoral muscle, extension can seldom
 be made, by the hands of assistants with sufficient force.
 —In such cases it will  be necessary to employ the pul-
 fres invented for this purpose,—Reduction may  also be 
      DISLOCATION OF THE RADIUS AND ULNA.    183

facilitated by bleeding,—the warm bath,—by the use of
opium,—and by the administration of a tobacco clyster..


        OF THE RADIUS AND ULNA.
  The radius, Avith the ulna, may be dislocated either
upwards and backwards, or partially imvards and out-
wards.—The radius may be dislocated forwards.
                    DIAGNOSIS.
  When the dislocation is upAvards and backAvards, the
fracture is shortened, and the olecranon of the ulna pro-
jects  beyond,  and is higher than usual;  the  extremity
of the humerus cannot be felt in the bend of the elbow.
  When imvard, the sight alone will be sufficient to as-
certain the displacement of the bone.
  When the radius is  dislocated  alone,  it is generally
throAvn fonvards on the external condyle of the hume-
rus.—In this case the rotatory motion of the arm is de-
stroyed ;—the fore-arm is so bent as to  form a consid-
erable angle Avith the  os humeri;—and the patient is
incapable of extending it.
                    TREATMENT.
  Extension is to be made by assistants  upwards  by
the humerus, and in a contrary direction downwards by
the fore-arm;  while the operator guides the protruded
bone  into its  cavity.—Reduction is sometimes more
easily  effected by making the knee the fulcrum of a
lever, by Avhich (in the dislocation backwards) the coro-
noid  process of the ulna may be lifted out of the cavity
formed for receiving the olecranon.
  When the dislocation happens  to be  either inwards
or outAvards, simple extension in the directions above
mentioned, Avith pressure of the extremity of the bone,
will in general alone be sufficient. 
18-i         DISLOCATION OF THE  HIP
                OF THE WRIST.
  The Avrist m.?.y be dislocated  either hvwards, out-
wards, or backwards.
                    DIAGNOSIS.
  The sight alone is sufficient to ascertain  the  nature
of the injury.—In the dislocation backwards,  where
there is generally much SAvelling and tension, by tracing
the bones of the fore-arm, the unusual projection form-
ed by the carpus may readily be discovered,
                   TREATMENT.
  As the preceding dislocation.
                  OF  THE HIP.
   The os femoris may be dislocated in four different
directions.
j. Downwards into the foramen ovale.
   In  this case the leg is lengthened by an inch and an
half;—the knees are forcibly separated from each oth-
er ;—the foot is turned outwards;—a vacancy is per-
ceived in the parts Avhich the head of the bone and the
great trochanter usually occupy.
                   TREATMENT.
  A strong  belt or roller  must be  passed  round the
pelvis, and the ends carried over the hip of the sound
side, where they are either to be firmly held by assist-
ants, or confined to some immoveable bodv.__A second
roller is noAV to be passed  between the thighs, and its
extremities  carried in a direction contrary to the first
applied ; i. e. over the dislocated hip.—By the latter of
these, extension is then to be made in a direction up-
wards and outwards ;  the former meanwhile being 
DISLOCATION OF THE HIP.          185
prevented from altering its position.  The operator is
at the same time to endeavour to elevate  the head of
the bone over the projecting acetabulum, by means of
a sling  passed over his own shoulder, and under the
thigh of the  patient.—Reduction will be effected with
greater facility, if  the knee be bent to a right angle
Avith the body, and pushed iiwards towards the opposite
leg.
II.  Forwards on the fiubes.
                    DIAGNOSIS.
  The  head  of the bone is distinctly felt in the groilT^
while the projection of the  hip, and the usual  fulness
surrounding  it,  are lost.—The  foot  is considerably
turned  outwards ; but the length of the leg is not al-
tered.
                   TREATMENT.
  Differs from that recommended for the preceding,
only in  the extension being required to be made in a
direction directly outwards; Avhilst the knee is elevated
to a right angle with the body.
in.  Upwards and backwards on the ileum.
                    DIAGNOSIS.
  The leg  is considerably shortened, as may be easily
discovered by comparing it with that of the sound side ;
—the foot  is  turned much inwards ;—the limb will not
admit of rotatory motion, and the great trochanter, on
that side, is felt considerably higher than on the oppo-
site.
                   TREATMENT.
  The  belt must be passed around the pelvis, and se«
cured, as directed for the first  dislocation.—A  second
is to encircle the  dislocated thigh, immediately above
                        R2 
186       DISLOCATION OF THE PATELLA,

the knee, and with this, extension is to be made ob-
liquely downAvards, and toAvards the other leg.
iv. Downwards and backwards into the foramen ischii.
                    DIAGNOSIS.
  The leg is lengthened only in a slight and impercep-
tible degree ;—the projection of the trochanter is lost,
—the foot is turned greatly inwards.
                   TREATMENT.
   The body being secured in the usual manner, the
thigh is to be drawn upwards toAvards the abdomen, and
depressed against the other leg, when extension is to be
made  outAvards  and rather upAvar ds, by  mean  of a
roller passed around the thigh above the knee, as before
directed ; but the utmost perseverance and skill  will
often be insufficient to. effect reduction when the hip
has been thus dislocated'.
               OF THE PATELLA.
  The patella may be  luxated  either sideAvays or up-
wards ;  in which latter case, the ligament with which
it is connected  is torn  through, and the bone is drawn
up several inches among the muscles of the thigh.—
The nature of the case can be distinctly ascertained,
both by the sight and by manual examination.
                   TREATMENT.
  In the dislocation sideAvays, the limb must be firmly
Extended ;  when pressure being  made upon the pro-
truding edge, either  directly inwards, or  rather doAvn-
wards,it immediately regains its former situation.
  The dislocation upAvards is to be treated precisely as
& transverse fracture of the bone j  which see. 
          INFLAMMATION OF THE BONES,        187

                OF THE TIBIA.
  The tibia may be dislocated partially, either inwards,
outwards, or baekAvards.
                    DIAGNOSIS.
  The situation of the dislocated bone is obA-ious to the
sight.
                   TREATMENT-
  Extension is to be made upwards by the  femur, and
downwards by the fore-leg, while the bones  are re-
placed by pressure with the hand,


             .  OF THE ANCLE.
  A dislocation of this joint may take place either in-
wards, outwards, or fonvards.
                    DIAGNOSIS.
  The two  former cases may be ascertained by the
inclination  of the foot, and by the unnatural protube-
rance on one side and deficiency on the other.
  When the tibia is forced fonvards on the tars-U3, the
foot is considerably shortened ;—there is a great and
unusual  projection of the heel.
                    TREATMENT.
  Reduction is to be effected by extension, made in the
same manner as in a dislocation of the knee.


              DISEASES OF BONES.


                INFLAMMATION.
                     SYMPTOMS.
   A peculiarly obtuse,  deep-seated, aching pain, ex- 
(98
ABSCESS OF THE BONE*.
tremely distressing to the patient, and soon affecting
the health  to  so  remarkable a degree as to induce a
speedy emaciation of the body.—The part at length
SAvells, and a tumor forms, possessing great hardness ;
—the skin becomes red and extremely sensible;—there
is an increase  of heat, with other symptoms of inflam-
mation.
                     causes.
  All the common causes exciting inflammation, more
especially external injury ;—syphilis ;—scrofula.
                   TREATMENT.
  If arising from common causes simply, as from a
bloAv, 8cc. topical  bleeding  by  leeches ;—the  applica-
tion of blisters ;—fomentations ;—pain allayed by opi-
um ;—after pain and redness have subsided, mercurial
friction ;  hydrargyrus muriatus internally. •
  If from syphilis, the means laid down under that
disease.
  If from scrofula, evacuations are to be avoided ;—
blisters kept open by the use of the ceratum  canthar-
idis ;—the external use of mercury ;—the emplastrum
ammoniae of  the. Pharmacopoeia Chirurgica.   Vide
White Swelling."
                    ABSCESS.
                    SYMPTOMS.
  The symptoms of inflammation before enumerated ;.
—the preceding pain has usually been exceedingly se-
vere and constant, and attended with great constitution-
al irritation, quick hard pulse, white tongue ;—the in-
teguments become  swelled and mflamed, and have an
emphysematous feel \—the patient is attacked with se- 
MORTIFICATION OF THE BONES.        *S9
vere rigors ;—an undulation becomes perceptible Avith-
in the tumor ;—ulceration takes place, and a thin acrid
matter is discharged; when, by an examination  Avith  a
probe, a cavity can be traced leaduig into the centre of
the bone.—The progress of the formation of matter is
sometimes extremely sIoav, at others the tumor soon.
becomes fluctuating.
                   TREATMENT,
  After attempts  have  been made in vain to produce
an absorption of the fluid by the means  before recom-
mended for the treatment of inflammation, it has been
found most successful to lay the Avhole  open by a free
incision ; then to remove part of the superficial  cover-
ing of bone by the common trephine, and aftenvards to
make use of stimulant and astringent injections, as tine-
tura myrrhae, to correct the  fetor  of the dischargea
and to promote the formation of granulations,
               MORTIFICATION.
              c,.   .     C   Exfoliation.
             Species.   <
                       C   Necrosis.
t.  Of exfoliation.
  Exfoliation is the casting off of a portion of the ex-
ternal part of a bone Avhich has lost its life.—The pro-
cess of separation is the same as  among soft parts ;—
ulceration takes place, granulations form between the
dead and living bone, and  the useless portion thus be-
comes detached and forced away.
                      CAUSE.
  It is most  frequently the consequence of a separa-
tion of the periosteum by Avhatcvcr means, or of exter-
nal injury. 
190         MORTIFICATION OF THE BONES.

                   TREATMENT.
  The process of exfoliation of the bone is to be expe-
dited by the application of stimuli.
  Tinctura myrrhae.
  The acetous acid is used in the Gloucester Infirma-

  Avery diluted solution of nitrous acid in Guy's Hos-
pital.
  The alkohol caryophyllatum of the  Pharmacopoeia
Chirurgica,
B. Alcohol 3'ij.              Take Spirits of Wine 3'tj.
  Olei caryophilli 3j.  M.      Oil of Cloves  £j.    Mix.
  Perforation of the bone has been practised with suc-
cess ;—and also the application of the actual cautery to
the dead portion.
II. Necrosis
  Is the separation of an internal portion of a bone.—
The surrounding parts become much enlarged and
thickened ;—inflammation at length takes place upon
the external surface ;—ulceration ensues ; many holes
are formed, and upon examination the dead portion is
found detached and lying loose Avithin the cavity form-
ed by tne absorption of the contiguous bony structure.
                       CAUSE,
  Preceding inflammation, or accident; destroying the
life of the cancelli.
                    TREATMENT.
  After  ulceration has taken place, the  same  means
must be employed to promote a separation of the dis-
eased bone, as are before recommended : a very Aveak
solution of nitric  acid (p. 59); or dilute vinegar,  inject-
ed, by means of a  syringe, through the openings formed
by the ulcerative process.  These applications  should
be so dilute as not to create pain. 
               CARIES OF THE SPINE.            \''J l

  When a portion of bone can be felt completely loose,
the most speedy and effectual mode of proceeding is,
to make a perforation with the trephine, and extract it
with the forceps.


            CARIES  OF THE SPINE.
                    SYMPTOMS,
  Languor and listlessness ;—fatigue  upon slight ex-
ertion ;—avertion to motion ;—the patient is observed
frequently to trip and stumble Avithout any apparent
cause, and whenever attempts are made to move brisk-
ly, the legs involuntarily  cross each  other, and he is
thrown  down;—in an erect posture the  knees often
give  way and  bend fonvard;—an  obtuse  distressing
pain is felt in the back, Avith great Aveakness in the loins;
and, upon inspection of the spinous  process of the ver-
tebrae, one or more is found to project beyond the rest.
—Soon after this the  extremities lose  much of their
natural sensibility, and at length become quite useless,
although  often  not until the expiration of a very con-
siderable time from the first appearance of the disease.
                       CAUSE.
   Scrofula ;—accidental injury done to the spine.
                      DIAGNOSIS.
   From common paralysis.—In common nervous palsy
 there is a peculiar flabby feel of the  paralyzed  parts ;
 the joints are seemingly loose, and have a preternatu-
 ral  mobility;  there is an  incapability  of resistance,
 which  allows the limb  to be tAvisted in any direction.
 In the present disease the parts are more tense to the
 feel; the joints,  particularly the ancles, possess con-
 siderable rigidity, by which the feet are  often pointed 
i\)2
EXOSTOSIS  OF BONE.
doAvmvards ;—added to these, the affection of the loins
sufficiently points out the nature of the disease.
                   TREATMENT.
  A caustic issue, such as is directed, when  speaking
of the disease of the hip, to be made on each side of the
protuberant portion of the spine, and suffered to remain
open until the patient recover the use of his limbs ; at
the same time employing tonics and  other  remedies,
recommended for the cure of scrofula, and occasional-
ly sprinkling the sore Avith a small quantity of finely
poAvdcred cantharides,
                   EXOSTOSIS
   Is a morbid growth of bone, forming a circumscrib-
ed tumor of  great  hardness; which  sometimes ac-
quires an immense size ;—it is  most frequently met
with upon cylindrical bones :—it is sometimes firmly
osseous; at others of a cretaceous consistence, and
often partly cartilaginous.
                      CAUSE.
   A diseased action of the bone from an uncertain
cause.
                    TREATMENT.
   If formed  upon a part  little  essential to life, and
when of no very considerable size, it may be removed
Avith perfect safety.—In performing the operation, the
integuments should be saved, that they may aftenvards
be united by the first intention; and the tumor, if per-
fectly osseous, requires the use of a  small saw for its
removal. 
   FRACTURE  OF THE BONE9 OF THE NOSE.   I9-

                 RACHITIS.
Vide medical works on this disease.
            MOLLITIES  OSSIUM.
  This  disease is peculiar to the adult period.—The
bones insensibly become soft, until, being incapable of
withstanding the action of the muscles, they are bent in
various  forms ; precisely as in rachitis.
  Sometimes a peculiar friability takes place, Avhich
renders them susceptible of fracture from the slightest
causes.
                      CAUSE.
  The cause inducing this disease is unknown ; it conj
sists in  an absorption of the earthy parts of bone.
                    TREATMENT.
  Nutritive aliment;—tonics, and other means of in-
vigorating the system, recommended for the cure of
scrofula.—The disease, Avhen once established, gene-
rally, in spite of medical  assistance,  goes  on  to  the
destruction  of the patient.
                  FRACTURE
  Is a division of bone into tAvo or more fragments;
generally occasioned by external violence.
            fl. Simple;—where the bone  has been
                divided, and the integuments remain
                unimpaired.
Species.    J 2> Compound;—where there  is a cor-
                responding wound  in the soft parts,
                by  Avhich the fractured extremity of
                the bone becomes exposed,
                          S 
194       FRACTURE  OF THE tOAVER JAW.

                     CAUSES.
  Predisposing.—Certain diseases of the bone ; as ab-
scess, friability, or mollities.
  Exciting.—External violence,
                   TREATMENT.
            f  i. To reduce the displaced parts to
                    their original situation.
Judications.^   n.  To retal them in that state.
              in. To obviate any attendant or conse-
            l_    -   quent morbid symptoms.


       OF THE BONES  OF  THE NOSE.
  Fractures of the bones of the  nose, though produc-
tive of little inconvenience at the time,  are not unfre-
quently folloAved by unpleasant consequences ; as ozec-
na,  polypus, See.
                    TREATMENT.
  The  fractured portion  may  be easily replaced by
means of a common spatula, or other instrument, in-
troduced by the nostril, and in general it will retain its
situation Avithout any further assistance.
            OF THE LOWER JAW.

                    DIAGNOSIS.
  The nature of the injury is obvious to the sight.
                   TREATMENT.
  The parts being accurately replaced and kept firm by
an assistant, a thick compress of lint should be  placed
over the seat of the fracture, and a bandage applied, by- 
           FRACTURE OF THE CLAVICLE.       195

means of Avhich the jaAV may be firmly held  upwards
and backwards ;—for this purpose  the  most  effectual
is a bag or purse, to receive the chin, Avith four strong-
tapes, or ends, attached to it;  the tAvo  inferior of
which are to be tied over the parietal bone, the two su-
perior over the occiput.
  During the cure the patient should be  kept quiet,
and fed upon spoon-meat.
              or THE CLAVICLE,
                    DIAGNOSIS.
  The shoulder is usually draAvn fonvard, and that por-
tion of bone Avhich is attached to the sternum, projects
over the other fractured extremity, and may be distinct-
ly felt by tracing the usual course of the clavicle with
the finger.
                   TREATMENT.
  The arms and shoulders of the patient are to be firm-
ly draAvn  backwards by an assistant; Avhen the fractur-
ed extremities of the bones immediately come in appo-
sition.—The parts are noAv to be covered with an ad-
hesive plaster, and a bandage is to be applied to retain
them in their reduced  situation ;—that called the stel-
late is  usually employed ;  it is a single-headed roller
of moderate breadth, and is applied by making it to pass
under the axilla of one side, and over  the shoulder of
the opposite, describing on  the back the figure 8.—I:
should be draAvn  Avith  considerable tightness, and the
arm should afterwards be supported with a sling. 
196         fRAOTURE  OF THE SCAPUL.v

                 OF THE  RIBS.
                     DIAGNOSIS.
  The characteristic marks of a fracture of the ribs arc,
the crepitus or grating of the bones, which may be dis-
tinctly felt and heard  upon the  patient coughing,  or
during a deep inspiration ;—the pain, Avhich in inspira-
tion is referred to a particular spot.
                   TREATMENT.
  An adhesive plaster, or the ceratum saponis of the
London Pharmacopoeia, should  be  applied over  the
part,  and  the body should then be  tightly encircled
Avith abroad bandage.
  Should  the extremity of the fractured rib puncture
the lungs, an effusion of air  into the  cellular mem-
brane Avill take  place;  and sometimes will extend to
the scalp, the eyes, and  doAvnwards, along the abdo-
men,  to the loAver extremities.—In such  cases small
scarifications AA'ith the point of a lancet are required ;
and if there be  symptoms of fever,  or inflammation,
bleeding and the antiphlogistic regimen.
              OF  THE  SCAPULA,
l-  Of the cervir,
                    DIAGNOSIS.
  Fractures of the scapula most frequently happen at
Us cervix ; and in this situation it has all the character-
istics of a dislocation of the shoulder, for which it is
not unfrequently mistaken.—The shotddcr is sunk, and
a hollow is perceived under the processes acromion.
—It is distinguished by rotating the arm with one hand,
at Mi- same- time applying the other to the neck of the 
          FRACTURE OF  THE HUMERUS.        197

scapula; when both bones will partake of the rotatory
motion, and generally a crepitus may be perceived.
                   TREATMENT.
  The same treatment is required as for a fracture of
the clavicle.
n. Of the acromin process.
                    DIAGNOSIS.
  The arm is generally mucli drawn fonvards ; but the
bone being so superficial, the place of the fracture is
easily distinguished.
                   TREATMENT.
  The shoulder must be firmly bound as above direct-
ed, and the fore-arm particularly Avell  supported by a
sling.


              OF  THE  HUMERUS.
                    DIAGNOSIS.
  The head of the bone being grasped Avith one hand,
and the elbow Avith the other,  upon rotating  the arm,
no motion will be communicated from the lower to the
upper portion, and at the same time a crepitus will be
distinguishable.
                   TREATMENT.
  In order to bring the fractured extremities  of the
bone in apposition, extension must be made in contra-
ry directions ;  at the same time relaxing the muscles
by bending the elboAv joint.—The arm is then to be en-
circled Avith a piece of soft flannel, and a splint applied
on each side ; the outer of Avhich should be of sufficient
length to reach from the shoulder to the elboAv.—After
which the Avhole is to be secured by a flannel or linen
                        S3 
 1>98        FRACTURE OF THE FEMORIS.

roller, applied sufficiently tight to support the parts in
the situation in Avhich they have been placed.—The
fore-arm is to be supported with a sling ;—confinement
is not in general necessary.
        OF THE RADIUS AND ULNA.
                   DIAGNOSIS.
  The existence of a fracture of these bones may be
ascertained in the same manner as directed for discov-
ering a fracture  of the humerus ; or by tracing  the
course of the bones with the finger along-their interior
surface.
                   TREATMENT.
  The same treatment is also required as in a fracture
of the humerus.—The splints should be laid,  one on
the inside, the other on the outside of the arm ;  so that
both bones may be at  once effectually compressed ;—
that on the inside should be long enough to reach  the
palm of the hand, by which means the wrist will be
kept steady, and the  radius will  be prevented from
rolling.—They may be confined either by the applica-
tion of a bandage, or by tying them with broad tapes
or riband.
             OF THE OS FEMORIS.
t. At its neck.
                    DIAGNOSIS.
  When the thigh-bone has been fractured at its neck*
the limb is remarkably shortened, and exhibits the ap-
pearance of a dislocation of the os femoris upwards, 
           FRACTURE OF THE FEMORIS.         199

  The two diseases are distinguished by the  position
of the leg and  foot; by the position of the knee and
foot;—which in  the  former are turned considerably
outAvards ; in the latter, inclined in the contrary direc-
tion ;  the  toe being remarkably turned  inwards, and
almost backwards.—By the  greater  or  less facility
with which the limb may be moved;—in  dislocation  it
can only be bent into a small angle with the body ; in
fracture it admits of being drawn up to nearly a  right
angle.—By the  accident in  question  most frequently
happening in  old  people.—By  the  crepitus  which
takes  place upon a forcible extension of the limb.
                   TREATMENT.
  To  retain the divided portions of bone in apposi-
tion, A-arious  means  have been proposed, and many
complicated instruments have been invented for the
purpose ;  but all attempts hitherto made have been at-
tended Avith nearly equally unsuccessful  results.—A
permanent shortening and disunion, Avith  loss of mo-
tion in the limb, has mostly been the consequence of
this deplorable accident.
  Union may, however, be attempted in  the following
manner:—The  limb  being forcibly  extended,  large
and firm compresses are to be laid upon the trochanter,
and strongly bound, by means of a bandage  rolled
round the hip, and betAveen the thighs of the patient.
—A strong deal  splint is next to be prepared, of suf-
ficient length to reach some way up the side, and this
is to be securely confined by means of bandages pass-
ed round the pelvis and above the knee.
II. In the  middle.
                     DIAGNOSIS.
  The presence of a fracture in this part is to be dis- 
200         FRACTURE OF THE PATELLA.

covered by carefully feeling  along the upper side  of
the bone, Avhen a projecting  point  Avill generally be
discovered ; and if at the same time the joint be rotat-
ed, a crepitus and preternatural motion at the fractur-
ed part will be obseiwable.
                   TREATMENT.
  The bone being reduced to its  usual position by ex-
tension of the limb, rags Avetted Avith a cooling lotion
—the aqua lithargyri acetati composita, or  a plaster
of  the ceratum saturninum, or ceratum  saponis,
should be laid upon the part,  and over this the many-
tailed bandage.—Three broad  splints  should next be
applied,  one on each side of the thigh, and a third on
the upper part;  that on the outside being sufficiently
long to reach from the  hip to  the knee ;—these being
confined with tapes, the limb may hoav be placed either
in an upright position, in a fracture-box, Avith the knee
bent to a considerable angle,  or the thigh may be laid
smoothly upon a pilloAv on one side, a little  out from,
and higher than the body.
  The patient should be laid on a hair mattress, rather
than on a soft bed ;  and if symptoms of  inflammation
succeed  the accident, the bandage previously applied
should be frequently moistened with  cold lotions ; and
should there be much tension  and pain, they ought to
be entirely removed, and leeches, may be applied to the
part.


              OF THE PATELLA.
  The patella may be fractured in two directions; lon-
gitudinally, and transversely.—In the latter case, the
upper portion is drawn up  several inches among the
muscles of the thigh. 
       FRACTURE OF THE TIBIA AND FIBULA.     201

                    TREATMENT.
  In the longitudinal fracture, continued extension of
the limb, and the application of a bandage to the knee,
will be sufficient to effect a speedy union.
  In cases of transvere fi-acture of the patella, owing
to the great separation of the divided portions, it is ex..
tremely difficult, and nearly impracticable, to effect an
union by bone.—The fractured portions being made te
approach  each other as nearly as possible, the middle
of a roller of considerable length is to be applied over
the upper or ascending part of the patella, and being
carried round the thigh just above the joint, it is to be
crossed under the ham, and again on the upper part of
the tibia;  and having thus described the figure 8 around
the joint, it is to be properly secured, and daily increas-
ed in tightness.
  In order to maintain a perfect.extension of the limb,
a splint, Avell lined with wool, may be  applied under
(he ham.


            OF  THE OLECRANON.
  When the olecranon has been separated from the ul-
na, the same retraction takes place as in a fracture of
the  patella; and  precisely the same treatment is re-
quired.


        OF THE  TIBIA  AND FIBULA.
                    DIAGNOSIS.
  Fractures of these bones may be knoAvn to have tak-
en place by the irregularity discovered  upon carefully
feeling along their prominent edge :—by the unnatural 
'i02-
0OMP0UND FRACTURE.
motion  at the fractured part ;—and by the orepitus
created by pressure, or an attempt to rotate the leg.
                   TREATMENT.
  The  same refrigerant Avash, or  saturnine or  soap
plaster, will be proper, as in fracture  of the femur ;
and over one of these the  many-tailed bandage.—Tavo
splints are then to be applied, the one on the outside,
the other on the inside of the leg:—the best for this
purpose are Martin's whalebone splints.—In applying
them, care should  be taken that the outside splint be
long enough to reach completely from the knee to the
toes.—The leg is iioav to be laid on its  side upon soft
pillows, Avith the knee a little bent.  The pilloAvs are
to be secured by a proper  application of tapes.
           OF THE FIBULA ALONE.
  A fracture of the fibula generally happens from two
to three inches above the ancle-joint, Avhich is always
dislocated—The foot is so much turned outwards as
to form a considerable angle at the fractured part.—
Upon moving the joint, a crepitus is to be observed,
                   TREATMENT.
  Splints are to be applied, and the limb treated as for
a fracture of both bones ;  Avith the exception of a
roller, which  is to be substituted in the place cf the
usual bandage.—It should at  first be loosely applied,
but aftenvards gradually tightened and extended to the
foot.


          OF COMPOUND FRACTURE.
  A fracture is called compound Avhen  it is accompa- 
COMPOUND FRACTURE,
203
lhed Avith a Avound in the integuments,  by Avhich  the
extremities of the divided bone are exposed.—There
is much SAvelling and inflammation of the part ;  exten-
sive suppuration ensues, Avith great constitutional irri-
tation.
                    PROGNOSIS
  Will be  draAvn  from the extent of the injury, and
from the constitution of the patient.
  Unfavourable circumstances  are, the  bone being
much splintered ;—supervening erysipelatous inflam-
mation ;—delirium ;—the division of large arteries ;—
disposition  to sloughing  from extensive  contusion of
the  soft  parts  ;—the  constitution of the patient im-
paired by inebriety ;—or by concomitant disease of the
lungs, or any other important organ,
                   TREATMENT.
  Any extraneous bodies Avhich may have got into the
Avound, or  small  detached  portions of bone, Avhich, il
suffered  to remain, Avould  increase the supervening
inflammation,  are  first to be cautiously  removed by
means of a  soft sponge moistened Avith Avarm Avater, or
by the forceps.—Should there be any haemorrhage, this
is to be suppressed by pressure, by the application of
dossils of lint, or bits  of compressed sponge ; rarely
Avill there be occasion for the use of the needle.—If the
fractured extremity of the bone protrude through the
wound in the integuments, it ought, if possible, to be
reduced to its  proper situation by manual exertions ;
but sometimes this is impracticable ; in which case
there will be a necessity, either for dilating the Avound,
or removing the protruding portion Avith the saAv.—If
the  fracture be transverse,  and the injury to the soft
parts of no great extent, the former is to be preferred  ; 
204
COMFOUND FRACTURE.
but if the bone be broken obliquely, and the protruded
extremity be so sharp-pointed, as to endanger the pro-
duction of great irritation were it to be reduced in that
state, it will be advisable, cither entirely to remove it,
or, having cut off its pointed end only, to reduce the
remainder by dilating the wound.
  The fractured portions of bone being brought in ap-
position union, if possible is to be effected by the first
intention ; but if the injury to the soft parts has been so
extensive  as  to render the attempt useless, a pledget
©f lint is to be applied to the Avound, the limb is to be
encircled with cloths wet Avith some refrigerant  lotion,
and aftenvards the many-tailed bandage is to be lightly
applied; all  pressure being avoided,  as  likely to in-
crease the attendant inflammation.
  The limb is either  to be supported  on pilloAvs,  and
placed in that position in which the Avound  may be got
at with the greatest facility, or it should be laid in an
appropriate fracture-box.
  If the inflammation run high,  recourse must be  had
to general or local bleeding,—refrigerantsr—opium in
large doses.
  In many instances an operation will become necessa-
ry for the removal of the limb.
  The circumstances requiring amputation are,
  1. Very extensive laceration or contusion of the soft
parts.
  2. An opening communicating with a large joint.
  3. The  division of large arteries.
  4. Hectic fever from an extensive suppurating sur-
face.
  5. Mortification.
  6. The bone greatly splintered.
  Should the operation be required to be performed 
                     6ALCULUS.                  -JC3

Smmcdiately after the accident, it will be advisable to
draw blood, in considerable quantity, from the incised
rtrterics of the stump, or from the arm.


     DISEASES OF THE URINARY AND
              GENITAL  ORGANS.


                   CALCULUS.
                     SYMPTOMS.
I.  Of calculus in the kidney.
   Pain in the loins increased by pressure ;—nausea and
vomiting, especially upon friction being applied  to the
back ;■—difficulty  of making water ;—the urine, after
exercise, often bloody, purulent, or mixed with sand.
II. Of stone in the ureter.
   Pain and numbness of the leg and thigh of the affect-
ed side ;—pain and contraction of the spermatic  cord ;
—retraction of the testicle ;—bloody, mucous, or puru-
lent urine ;—in some instances ischuria.—The  calcu-
lus generally  descends from hence  into  the  bladder,
when the folloAving symptoms suddenly take place :
in. Of stone in the bladder.
   Micturition ;—pain or sense of irritation at the  ex-
tremity of the penis, greatly  increased  upon making
water, to the evacuation of which there is frequently a
sudden stop, followed by an almost insupportable sense
of bearing doAvn ; and at the ejection of the least drops
the pain amounts  even to torture.—The  patient in
voiding his urine  is observed to place himself hi a po-
sition, in which every muscle may be as relaxed as pos-
sible ;—his  knees are bent, his  head resting against
                         T 
206
CALCULUS.
 some  object for support, Avhile he draws the prepuce
 forcibly over the glans penis.
   From the irritation of the bladder there are not un-
 frequently violent spasms of  the abdominal muscles ;
 or inflammation and suppuration of the internal coat
 of the organ itself, accompanied Avith  violent  rigors,
 bloody and purulent urine, and in some instances gen-
 eral convulsions.—The urine is sometimes even of the
 spissitude of size, owing to the large quantity of mucus
 Avith Avhich it is mixed.
                      CAUSES.
   Hereditary predisposition ;  probably connected Avith
 a gouty diathesis ;—-sedentary life ,<—a long use of fer-
 mented liquors ; and of Avines abounding with tartar ;
 or of waters Avhich have a large portion of earthy mat-
 ter suspended in them ;—the  long retention of  urine ;
 —the irregularities productive of gout.
                    PROGNOSIS,
   The prognosis will be drawn from the urgency of
 the symptoms, and from the  existence of certain cir-
 cumstances, which will determine the favourable or
 unfavourable event of an operation.
   Adverse circumstances are—extreme obesity ;—the
 patient being the subject of asthma, or other disease
 of an important organ ;—the constitution impaired by a
 previous dissolute life ;—extreme heat of the Aveather ;
 —diseases of neighbouring parts, as  of the  prostate
gland j—-ischuria ;—cystitis. 
trficatrons.J
                     «alculus.                 20-7

                    treatment.
               i. To palliate urgent symptoms.
               n. To endeavour to dissolve the calcu-
                    lus ; or prevent its further accre-
                    tion.
              in. To extract it by an operation, after
                    other attempts  for the relief  of
                    the patient have been unsuccess->
                    fully made.
                         i.
  If symptoms of inflammation, bleeding, general and
local ;  and other  remedies recommended for the cure
of nephritis and cystitis.
  Pain is to be alleviated by opium, administered in
large doses ;—by the warm bath  ;—-uva  ursi;—aqua
kali puri.
  By muriatic acid, as recommended in the  Memoirs
of the Medical Society, vol.  hi.
R. Acidi muriatici gutt. x—xx.   Take Muriatic acid drops x—
                                 xx.
In aquae cyatho ter in die sum-   To be taken three times a day in
     endae.                       a glass of water.
  Decoction of the garden leek.
  Copious emollient and opiate clysters.
  Terebinthina in the form  of clyster.
                         ii.
  By alkalies and aerated alkaline  solutions ;—natron ;
—soap ;—kali aeratum ;—aerated soda-Avater.
  Professor Hufeland  and  others affirm, that a dilute
solution of pure  potash has reduced calculi to a sabu-
lous state.
  The carbonic acid alone  is recommended by  Han i-
?or> in the Memoirs of the London Medical Societv. 
308
CALCULUS.
  Some calculi  are acted upon by alkalies, others bj
acids.
  Mr. Jesse Foot recommends lime-Avatcr by the us^e
of vesicae lotura.
  Seltzer, Buxton, and Malvern waters.
                        m.
  Previously to determining on an operation, the actu-
al existence of a calculus in the bladder is to be well
ascertained by the introduction of an instrument called
i sound__This is performed precisely as the introduc-
tion of the common catheter ; and if  no cause of de-
ception be present, the percussion of the instrument
against the stone will give a vibrating sensation to the
finger at once decisive  : in general the sound is distin-
guishable also by the ear.
  Its presence being  ascertained, the patient, if of a
plethoric habit, should, on the day preceding that  de-
fcrmined upon  for the  operation, lose  a  moderate
quantity of blood ; an aperient should  be also adminis-
tered,  Avith  tepid  diluents,  and  on  the succeeding
morning an emollient enema ;  and he should be di-
rected to retain his urine, if  possible, for seme hours
previous to the time of operating.
                  THE OPERATION.
  These preparatory steps having been taken, the pa-
tient is to  be laid upon  a table considerably  higher
than is usual for other  operations;—his thighs  arc
to be  draAA'n  up to the abdomen, and the ancles  and
Avrists of each side  firmly bound together, by means.
of a noose formed in a piece  of strong tape—The
thighs should then be separated from each other, and
the nates being made to  project a little over the edge
ef the table, the  surgeon is to commence his operation. 
CALCULUS.
209
  He is first to introduce a grooved staff of proportion-
able size into the urethra and bladder,  the concave
surface of which he should incline to the left side ;  and
then deliver it to an assistant, Avho is  carefully to pre-
serve it in that position.
  An incision is hoav to be made on the left side of the
raphe of the perineum with a common scalpel, begin-
ning immediately beioAv the symphysis pubis, and con-
tinuing it obliquely doAvnAvards and outwards, to about
opposite the middle of the sphincter ani muscle.  By
this the muscles of the perineum will be exposed.—A
second incision is to be made between the bulb of the
urethra  and the  crus of the penis, at the same time
drawing aside the former with the fore-finger of the left
hand.  The transversus perinei, and a feAv fibres  of the
sphincter ani, will now have been divided, and the mem-
branous part of the urethra and prostate gland will be ex-
posed.—The third incision will be through the membra-
nous part of the urethra into the  groove of the staff.
  The next step in the operation is the introduction of
the gorget; and the knife may serve as a guide to the
passage of its beak into the groove : after Avhich the
operator is  to take the  staff from  the assistant, and
draAving it gently towards  him, the gorget is to be
pushed fonvard, in an horizontal direction, until it has
entered  the bladder ; the criterion of which is, the flow
of  Avater which then takes place,  and  the necessary
percussion of one instrument against the other.
   The  staff  is now  to  be withdraAvn, and the forceps
 passed along the groove of the gorget into the bladder,
and then cautiously moved about in different directions,
until, by striking against the stone, the situation of this
 is  discovered ; when the blades are to be separated,,
                         T 2 
210
OALCUHW.
and the stone grasped in the most favourable position.
which  may in great measure be  ascertained by the
greater or less degree of expansion of the handles.—
It should then be extracted in a slow and cautious man-
ner, directing part of the extracting force downAA-ards
on the  perineum, that it may Avith greater facility pass
under the arch of the pubis.
  Should  the  stone be too large to pass the angle
formed by the rami  of the ischia, it is  to be broken
doAvnby a pair of strong forceps usually made for this.
purpose, and each portion carefully removed by means
of an instrument called the scoop, and by tepid injec-
tions.
Subsequent Treatment.
  Pressure will in general be sufficient  to put a stop
to any haemorrhage that may take place,  provided the
operation  has  been properly conducted.—The wound
is to be treated with simple dressings ; and the legs of
the patient kept  constantly together, by means of a
bandage passed around the thighs.
  After the operation, the patient is to be laid in bed,
and an opiate administered.—After the expiration of
some hours, the  abdomen  becomes swelled and pain-
ful ; and should this arise to a high degree of inflam-
mation, with a quick hard pulse, recourse must be had
to the warm bath, to leeches, to fomentations and other
means recommended for the cure of cystitis.
     Of the Operation for the Stone in the Female.
  The treatment of calculus in the female differs only
in the mode of operating, which  is much more simple
than in the male.—A  staff less curved, and somewhat
shorter than that in common use, is first to be intro-
duced  ; and then Avith a gorget of the common strue~ 
STONE I.M T11F URETHRA.
211
mcc passed rather obliquely, the whole of the urethra
and neck  of the bladder is  to  be laid open, and the
operation  finished as before directed,


          STONE  IN  THE URETHRA.

  A stone lodged in the urethra is productive of much
local pain and SAvelling ; an obstruction to the passage
of the urine, and often a sudden  stop to its CA'acuation,
with painful contractions of the  accelerator urinae.—It
is generally perceptible to the  touch ; and gives the
same impression upon the introduction of a sound into
the urethra, if not contained in a cyst, as in the case of
stone in the bladder.
                    TREATMENT.
  If the  calculus be in the  membranous part of the
urethra, an incision must be made in the same manner
as in the operation for the stone in the bladder, betAveen
the bulb of the urethra and  cms of the penis; sup-
porting the stone by the  finger introduced at the same
time per rectum.   After it has been thus exposed, it
is to be hooked out Avith a tenaculum, or other appro-
priate  instrument.
  Should the calculus be further forward in the ure-
thra, the operation will be more simple, as the stone it-
self will be a sufficient guide to the incision.
  If it become necessary to  make an opening through
the scrotum, it Avill be advisable,  in  order  to  obviate
the consequences of effusion of urine, to introduce the
metallic elastic catheter, invented by Mr. Smith, and to
suffer  it to remain in the urethra, until union betAveen
the edges of the wound has been effected. 
212  INCONTINENCE OF URINE, OR ENEURESiS.

  When near the extremity of the urethra, the gradual
expansion of this canal with a pair of common forceps,
has in some instances been sufficient to allOAv of its ex-
traction.
       INCONTINENCE OF URINE, OR
                  ENEURESIS.
                      CAUSES.
  Relaxation or palsy of the sphincter vesciae muscle,
induced by  debility, the  abuse of spirituous liquors,
excess in venery, &c.;—irritation produced by calculi;
—injury clone to the parts, either by accident, by the
process of ulceration,  or by the unskilful performance
of the operation of lithotomy ;—the  pressure of the
uterus in the state of pregnancy.
                   TREATMENT.
  When from relaxation  or  paralysis, tonics;  *bark,
steel ;—cold bathing ;—cold lotions applied to the re-
gion of the pubis ;—cold Avater dashed daily over the'
pudenda ;—the application of cold substances to the
perineum ; as cloths Avet with vinegar and Avater.
  Electricity ;—terebinthina;—tinctura cantharidis ;—
uva ursi;—lime water ;—blisters  to the  perineum ;—
zincum vitriolatum,—balsamum copaivae.
  If these be ineffectual, the constant use of the ju-
gum penis in the male, and  of the  pessary in the fe-
male.
   Whenfrom the irritation of calculi, opiates ;—muci-
laginous diluents ;—removal of the  cause of the dis-
ease ;—recourse must be had to the use of urinals.
   Whenfrom  laceration  of the parts, the constitution
is to be invigorated by tonics, and other means  are to 
      STRAXGURY,  OR RETENTION  OF URINE.   213

be  employed for procuring union of the divided parts..
See Ulcer.*?'
   From  the pressure of the uterus.  Sse  Avorks on
midwifery.



  ©F STRAXGURY,  OR RETENTION- OP TJRIXE ; OR
              DYSUIUA AND ISCtlURl \.

               DIAGNOSTIC SYMPTOMS.
i. Of strangury.
   Frequent inclination to make water,  attended with
smarting pain,  heat,  and difficulty in  voiding it,  to-
gether Avith sense of fulness in the region of the bladder.
n. Of retention.
*   An accumulation of urine in  the bladder is discov-
ered by the pain  and distention of that organ, evident
in an examination of the hypogastrium ;—by the  vio-
lent efforts to discharge the water, occurring at inter-
\-als ;—by the excruciating pain, and often  by all t Uc
symptoms of cystitis.—Sometimes, Avhen the bladder
has suffered its utmost  distention, the urine runs off
from the urethra, as fast as it is brought by the ureters ;
and at others the patient  is able, at intervals, to make
a small  portion of urine ;—yet in both cases the com-
plaint still continues unremoved.
                       CAUSES.
   Want of tone in the* body of the bladder; induced by
any caus°, but chiefly by a too long retention of its con-
tents.  Spasm at the neck of the bladder ;—inflamma-
tion  induced by  stimulating diuretics, or by  other
rans-s of cystitis ;—the  pressure of the enlarged uter-
us ;—calculus impacted in the  urethra, or in the neeh 
■':-' )4    STRANGURY, OR RETENTION OF URINE;

of the bladder ; or gouty matter deposited  in  these
parts ;—spasmodic or permanent stricture ;—disease
of the prostate  gland;—fleshy  excrescences in the
urethra;—tumors  of  contiguous parts ;  as  haemor-
rhoids, polypi of the bladder, Sic.
                   TREATMENT.
Of strangury.
  When  arising  from  simple  irritation,  plentiful
draughts of Avarm diluent liquids;  as  barley-water,'a.
thin  solution of gum Arabic,  linseed-tea with a small
portion of nitre dissolved in it;—fomentations to the
pubes  ;—copious emollient and opiate clysters ;—opi-
um ;—uva ursi;—an infusion  of  the seeds of the dau-
cus sylvestris-—If the disease  arise from any other  of
the above causes, the treatment will be that altenvards
to be laid doAvn for retention.
Of retention.
  The first step in the treatment  of retention of urine,
from Avhatever cause, should  be  an attempt to  draw
off the collected urine, by the  introduction of a cathe-
ter into the bladder—Should this be successful or not,
the means to be pursued in other respects will depend
upon the cause inducing the disease.
I.  Loss of tone.
  The muscular  structure of the bladder  is to  be
strengthened by the means recommended for the  cure
of incontinence  of urine from the  same cause, which
see; and recourse must be had  to the frequent intro-
duction of the catheter as a temporary relief.
11. Retention of urine from inflammation.
  Consult medical Avorks on the treatment of Injlam.
mation of the Bladder.
III. Spasmodic Stricture. 
       '.'iRANGUny,  OR RETENTION OF  URINE.   21J

   The existence of this cause is denoted by the sudden
 accession of the disease, and by the violent and exqui-
 sitely painful spasmodic contractions of the accelerator
 urinae.—After repeated and unsuccessful attempts to
 introduce the catheter,—-copious bleeding;—the Avarm
 bath ;—nauseating doses of emetic tartar;—emollient
 and opiate enemas ;—the  tinctura  ferri  muriati—ten
 drops  every ten minutes is recommended  by  Mr.
 Ciine ;—opium Avith vitriolic  aether;—blister to the
 perineum ;—the operation.—Its return has often been
 prevented by the use of hydrargyrus muriatus.
 Iv. Permanent stricture.
   See  Stricture.
 V. Disease of the prostate gland.
   Vide the treatment of that disease.  ''
 vi. Pressure of the uterus in pregnancy.
   See works on midwifery.
 vn.  Tumors or excrescences in and about the urethra,
   Extirpation by the knife,—by ligature,—or by caus-
 tic ;  according to the size and  situation of the tumor.
 «—If small, the  frequent introduction  of a common
 bougie, or the continued use of a metallic, one.
   Should the means  recommended for the treatment of
the particular  causes of the disease above mentioned
 prove unsuccessful,  and after repeated attempts to in-
 troduce the catheter or bougie have been fruitlessly
 made, the only resource to be had recourse to for the
 relief of the patient is the operation of puncturing the
 bladder.
                 THE  OPERATION.
   A puncture may be made into  the bladder in three
different  situations. 
 216   -TflANGURY, OR RETENTION OF URINE-

               i. In the perineum.
              n. Through the rectum.
              iii. Above the pubes.
                         1.
   In the perineum.—The patient being secured  as in
 the operation for the stone, an incision is to be made on
 the left side of the raphe  of the perineum, commenc-
 ing  immediately beloAV the symphysis pubis,"and con.
 tinning it between the bulb of the urethra and crus of
•the  penis, until  the prostate gland is exposed, or can
be distinctly felt.—This is eoav to be pressed to one side
 with the finger of the left hand, Avhije, Avith the right a
 small trochar  is  introduced into the bladder a  little
above  it,  and to its  side.—The stilette  being with-
drawn,  the canula is to  be secured by proper  ban-
dages.
                         ii.
   Through the rectum.—In this operation the finger,
previously introduced into the rectum, is to be made
the guide to a curved trochar, in  length about five
inches,  Avhich is  to be passed into the bladder immedi-
ately beyond the prostate gland ; and the stilette being
 withdravrn, the canula is  to be  secured by a bandage,
and suffered to remain until the cause of  the obstruc-
tion has been removed.
                        in.
  Above the pubes.—This operation, as performed by
Mr. Hunter, is described  by  Mr. Home as follows  :
  A small opening being made Avith a lancet through
the integuments, immediately  above  the pubes, the
os pubis was felt  for,  and made a guide to the trochar,
which was then passed immediately behind it perpen-
 dicularly into the bladder.—Upon  withdrawing   the 
RUPfCRE OF THE URETHRA.
air
trochar, a flexible gum catheter was introduced in its
place, and  the  canula then slipped out over it.--The
catheter Avas retained l>y means of a bandage  passed
around the body.


       RUPTURE OF THE URETHRA.
                    SYMPTOMS.
  The scrotum becomes suddenly distended and saa'cII-
ed to a large size,  Avhich is increased upon every at-
tempt to void urine ; and upon endeavouring to intro-
duce a  catheter,  this is found impracticable.—The
urine is  retained with excruciating pain, and if means
are not taken to evacuate it, numerous abscesses form,
hectic fever arises,  and a fatal termination ensues.
                      CAUSES.
  External violence ;—stricture, preventing the free
passage of the urine,  hence producing a morbid accu-
mulation and a bursting of the urethra ;—stone impact-
ed in the urethra operating in the  same manner.
                   TREATMENT.
             fi. To evacuate the effused urine.
             ii.  To remove the cause which induced
                  the disease, if it still  remains and
            L     becomes an obstacle to the cure,
                         i.
  For this purpose a free incision is to be  made  into
the tumor, and the collected urine being evacuated,
the Avound should be kept open, by the application of
appropriate dressings, until granulations arise, and the
communication with the urethra is nearly closed, when
a bougie  should.be daily passed, to prevent a conse-
quent contraction of the canal of the urethra;
                        U 
218
FISTULA  IN PERINEO.
                        II.
  Should  the  disease haA'e arisen from an obstruction
in the urethra, either by stricture, or by the presence
of calculus,  it -will become necessary, after having eva-
cuated the  urine, to  remove  the  obstructing cause.
Vide Calculus in the Urethra and Strieture^-Thc stric-
ture may in some cases be advantageously dilated Avith
the  knife,  at the time the incision is made for letting
out  the effused fluid.
            FISTULA  IN PERINEO
   Is a sinuous or fistulous ulcer in the perineum, com-
municating Avith the bladder, or Avith the urethra.
                     CAUSES.
  It is generally the consequence of rupture of the
urethra, produced by obstruction of whatever nature ;
most  frequently by  stricture.—It  sometimes  arises
from  an abscess forming in one of the lacunae  of the
urethra, in consequence of gonorrhoeal inflammation.
                   TREATMENT.
  The  first object will be to remove the cause of the
obstruction ; without which  the sinus cannot be made
to fill up.—The  means of doing this are enumerated
under the heads  Stricture, So. &c.
  Should the cause already have been removed, a staff
should be introduced into the bladder, and a probe or
small director being passed through the external open-
ing until it reaches the groove  of the instrument, the
sinus  is to be dilated ; and if more than one, a commu-
nication is to be made between them.
  A preferable mode is to introduce the bougie or ca-
'hcter invented by Mr. Smith, and suffer it to remain in 
      ENLARGEMENT OF THE PROSTATE GLAND.  2 li-

the urethra,  occasionally  taking it out to be  cleaned ;
and afterwards to scarify the edges of the ulcer through-
out its Avhole extent:—.stimulating applications are  to
be applied to the Avound, as the unguentum hydrargyri
nitrati rubri, by which means granulations will be form-
ed, and the dribbling  of urine soon cease.
    ENLARGEMENT OF THE PROSTATE
                     GLAND.
                     SYMPTOMS.
  Sense of Aveight and bearing doAvn in the perineum j
frequent inclination to make water, with  difficulty and
pain in voiding it;—great costiveness ;—the evacua-
tion of faeces is  attended  Avith  much pain,  and is  in
general accompanied Avith a discharge  of urine ;—mic-
turition and dysuria increase, and at length a total sup-
pression takes place.
                    DIAGNOSIS,
  The urine and faeces discharged at the same time ;—
the patient in making water is  observed to kneel and
separate his  legs from  each  other, in order to effect a
relaxation of the muscles ;—an examination per rec-
tum, when a large  irregular tumor will be discovered
in the situation of the prostate gland.
                   TREATMENT.
  Recourse should be had to all those means Avhich al-
lay irritation in the  urinary  organs.  Vide CalculuVjL.
Tne internal use of opium,—cicuta,—hydrargyrus mu-
riatus ;—the occasional or constant use of a catheter. 
220
GOX0RRH0JA.
                 GONORRHOEA.
                    SYMPTOMS.
  About the fourth or fifth day after infection has been
conveyed, an uneasy sensation is felt at the extremity
of the  penis, Avith  a slight  degree of fulness  of the
lips of the urethra ; and in the course of a fcAV hours an
oozing of a whitish fluid is  perceived.  The sense  oT
pain soon becomes more acute, and is referred  to the
fraenum.
  In a feAV days the discharge from the urethra is much
increased, and assumes a greenish or yelloAvish hue ;—
a considerable degree of pain and scalding heat also is
experienced  on every attempt to make water, called
ardor urin&.—Vi the inflammation run high, a chord.ee is
a very frequent consequence ;—this is a painful and in-
voluntary erection, accompanied with an incurvature of
the penis downwards, and exquisite pain.—The adja-
cent parts sympathising Avith those already affected, the
bladder becomes irritable and incapable of retaining its
urine for any length of time ;—this gives the patient a
frequent inclination to make Avater, and he feels an un-
easiness about the scrotum, perineum, and fundament.
—Sometimes the  discharge is more copious from the
external surface of the glans, or from the membrane oi
the prepuce, when phymosis or paraphymosis arc not
unfrequently produced.   See  these diseases.—Often
there is an enlargement of the glands of  the groin,
Avhich however  is to be  considered as depending
merely upon irritation of the  lymphatics, and not as a
syphilitic bubo.—The inflammation sometimes extends
along the AA'hole course of the urethra, and even to the
bladder  itself,  producing actual cystitis.—In other in-
 stances it happens, more especially in the protract^ 
CONORRHIEA.
22;
 sfare of the disease, that OAving to  the rupture of a
 small vessel, a  haemorrhage proceeds from the penis,
 occasioning alarm to the patient, but easily stopped
 by pressure upon  the urethra.—Spasmodic stricture,
 Avith  retention  of urine, are likewise  at  times the
 effect of the  great  irritability of the parts;  and in
 some instances a suppression of the evacuation from the
 penis, by cold, or other causes, has been folloAved by
 inflammation of  the prostate gland and bladder, and of
 the uterus in women.
   After a longer or shorter time, generally in about
 fourteen days, the  discharge, from having  been thin
 and discoloured, will become white and of a ropy con-
 sistence, will gradually diminish in quantity, and at last
 cease entirely, together with every other inflammatory
 symptom.
   In women the  symptoms are similar to those before
 enumerated as happening to  the  male ;  there is the
 same heat and soreness in making water, and the same
 discharge of discoloured matter from the urethra and
 neighbouring parts  though generally less severe ;—it
 sometimes happens that  a great  enlargement  of the
 nymphae takes place, Avith an inflammation of the Avhole
course of the urethra, so as  to  cause retention of
 urine.
                     CAUSE.
  An inflammation  of the mucus membrane  of the
urethra, induced  by the action of a specific virus.
U2 
                    GONORRHffi.i .

                   TREATMENT.
                 To diminish inflammation.
                 To alleviate  pain, and other urgent
                    symptoms, to which  the disease
Indications.**            .
           ^        may have given  rise.
            | ih. To suppress the discharge from tht
            |        urethra, after the  inflammatory
            L       symptoms have  subsided.
                        Iv
  By a spare diet;—abstinence  from animal food, and
fermented liquors;—aA'oidmg exercise.
  If the inflammatory symptoms run high, by general
bleeding ;—purging ; with magnesia vitriolatiy or cal-
omel with rhubarb.
  Diluents -T frequent and  copious draughts of a dc-
coction of pearl-barley, or linseed, with the addition of
gum Arabic and a small portion of nitre.
  Sedative  and  refrigerant applications.to the  external
parts ; the aqua lithargyri acetati composita.
  Warm fomentations, and the immersion of the penis
in Avarm water,  are sometimes more effectual.
                        ir.
  To abate pain, by the administration of opium ;—
cicuta.
  Narcotic fomentations, of cicuta or poppy-heads.
  Injections, of a watery solution of opium ;  or fresh
cream diluted with Avarm Avater.
  Spasm with  suppression  of urine.—Sec Spasmodic
Stricture.
  Hemorrhage  from the urethra.—"By a compress ap-
plied to the perineum, and secured by means  of the T
bandage ;—the  introduction of  n large bougie :—cold 
GONORRIRT.A.
223
applications to the  perineum,—vinegar and Avater ;—
astringent and sedative injections,—ccrussa acetata.
   Inflammation of  the prostate  gland—indicated  by
much heat  and pain  in the perineum, and thence ex-
tending to the rectum ;—by leeches,—fomentations,—
poultices,—emollient clysters.
   Sympathetic enlargement of the glands of the groin.
-—By the application of leeches ■r—cold lotions ;—per-
fect rest.
   Hernia humoralis.—See that disease*   Q '
   Phymosis and paraphymosis.—'See these diseases.
                           in.
   1st,  By astringent injections ; a very diluted solution
 of vitriolic acid,—of zincum vitriolatum,—zincum ace-
 tatum,—of cerussa acetata,—cup-rum ammoniatum ;
 __where  there is reason to suspect the existence of
 ulceration—-of hydrargyrus  muriatus,  or of calorael
 joined with lime-Avater.
 R. Acidi  vitriolici diluti gutt. Take Sulphuric acid diluted
           viij.                           drops viij.
    Aqua: distillatae  5viij.         Distilled -water $viij.
 T iat injectio.                  Make an injection.
R  Zinci vitriolati gr. viij.
   Aquae distillatae ?viij.
Fiat injectio.
Take Sulphate ofzincgvs. viij.
  Distilled water T viij.
Make an injection.
R. Zinci acetati ^ss.
   Aquae distillatx 5viij.
Fiat injectio.

R, Cerussa acetatae 9ss,
   Aqus distillata: 5viij.
Fiat injectio.
Take acetate of zinc ^ss.
  Distilled water %viij.
Make an injection.

Take Acetite of lead 9§»..
  Distilled water 5viij,
Make an injection, 
224
GONORRHOEA.
R. Cupri ammoniati gr. iv.      Take Ammoniated copper  grs.
IV.
   Aquae distillatae ?viij.        Distilled water zviij.
Fiat injectio.                Make an injection.
R. Hydrargx ri muriati gr. ij.   Take Muriate of mercury grs. ii.
   Aquae distillatae rviij.        Distilled water 2viij.
Fiat injectio.                Make an injection.

R. Calomelanos Jss.         Take Sub-muriate of mercury Jss.
   Aquae calcis 5viij.           Lime water ^viij.
Fiat injectio                Make an injection.
   These injections should be used cold every three or
four hours.
   For women, a drachm of the zincum vitriolatum and
acetatum, and cerussa  acetata, should be dissolved in
half a pint of water.
   2dly, By the internal  use of astringents and  tonics ;
balsamum  copaivae,—ferrum  vitriolatum,—cinchona,
—terebinthina.
   In  some cases, after every inflammatory symptom
has disappeared, in consequence of a relaxation of the
mucous glands of the urethra, induced by repeated at-
tacks of  gonorrhoea, from other causes, the discharge
long  remains, in some instances even for the remainder
of life, and resists every remedy employed for its sup-v
pression : in this state it is  denominated a  gleet.—
Recourse should be had to the injection of powerful as-
tringents ; a solution of alum in decoction of bark,—hy-
drargyrus muriatus,—cuprum vitriolatum,—solutions
of sal ammoniac,—tincture of cantharides,—cold water
frequently  dashed upon  the  pudenda,—daily use of
the cold bath,—-blisters applied frequently ,to the peri-
neum. 
GONORRHOEA.                    -v ~$
It. Aluminis purificati ^j-
   Decocti quercus Zviij.
Solve ut fiat injectio.
R Hydrargyri muriati gr. iv.
   Acidi muriatici gr. j.
Terantur  simul  in   mortario
  vitreo, d'ein adde—

   Mucilaginis Arabici xj.
   Aqux distillate 2vij.
Fiat injectio.
Take Roch Alum $1
  Decoction of Oak Bark zviij,
Solve and make an injection.

Take muriate of mercury grs-,
       iv.
   Muriatic acid grs. i.
Rub them together in a glass
       mortar, and add
   Mucilage of gum Arabic ri-.
   Distilled water ±vij.
 Make an injection.
R. Cupri vitriolati gr vj.       Take sulphate of copper grs. vi,
   Aqux distillatx 5 viij.         Distilled water gviij.
Fiat injectio.                  Make an injection.
   The internal  use  of tonics, especially of chalybeates
and of  astringents, is  also necessary; as  balsamum
copaivae,—olibanum,—zincum  vitriolatum,—cuprum
vitriolatum,->-alumy—tcrebinthina.
R  Balsami copaivx  ^jss.      Take balsam copaiva ^iss.
  Mucilaginis Arabici zij.
  Aqux cinnamomi %iv.
  Syrupi Tolutani rss.
iat emulsio cujus sit dosis
 cochlearia triater quotidie.
   J\lucilage of gum arabic zij.
   Cinnamon water ziv.
   Syrup of Tola -zss.
Make an emulsion, the dose is
   three spoonfuls,  three times r.
   day.
R  Dlibani ^j.                  Take Olibanum %f\.
   Zinci vitriolati gr. jss.           Sn'phate of zinc gr. iss.
    Balsami Peruviani q. s.       Balsam of Pern, q s.
Fiat pilule xii. quarum capiat  Make xij. pills ; let the palierJ
   ;<scr duas ter in die.            take two, three times a day.
Jt  Cupri  vitriolati gr. j.
   Extracti gentianx  5.]
Fiat pilul- xii quarum sit do-
   sis dux bis quotidie.
Take pulphate of copper gr.
  Extract of gentian %i.
Make xij pills-   Doic ij.  Ji
  a day. 
226                 sTnicTURE.
R. Aluminis purificati 2jj.      Take Rock Alum ^\.
   Extracti cascarillx 3jss.        Extract of Cascarilla Jiss
   Olibani pulverisati q. s.         Olibanum powdered, q s.
Fiat pilulx mediocres quarum  Make pills of a moderate size.
  sumantur tres ter in dies.      Dose iij. three times a day.
  In all such  obstinate  cases there will  ahvays be
reason to suspect the existence  of stricture:  this
should be ascertained by  the means  presently to be
mentioned.
  It may be necessary to  observe, that, although the
use of mercury is by most surgeons of the present day
admitted to be unnecessary to the cure of gonorrhoea,
yet that after all inflammatory symptoms have disap-
peared, and not until then, it  may  be used  by those
who are still increduious,- to ensure the patient from
the supposed danger of being afterAvards attacked  by
the constitutional  disease.
                  STRICTURE.
  A stricture is a thickened  and contracted state of
one or more parts of the canal of the urethra, producing
an obstruction to a free passage of the urine.
                     SYMPTOMS.
  Its presence is denoted by micturition ;—by the dis-
charge  of mucus from the urethra;—by the urine.
which is  greatly diminished in its stream; often split
into tAvo, or voided drop by drop.—A small tumor may
be felt in  the perineum, and upon attempting to intro-
duce an instrument into the urethra, an obstruction oc-
curs to its passage.—T.ere is often a concomitant dis-
ease of the bladder, producing  a discharge of purulent
urine. 
          STRICTURE IN THE  URETHRA.        *27

                      CAUSE.
  Preceding inflammation and ulceration, by Avhatcver
cause induced.
                   TREATMENT.
  The daily use of a bougie;  of Avhich the  best  for
this  purpose are the catgut and the  flexible metallic
bougies invented by Mr. Smith.—Previous to its intro-
duction,  it should  be  slightly curved, and covered
Avith some bland oil, or unguent, to prevent irritation.
—It ought to be Avorn at first for about  half an hour,
gradually increasing the time  from day to day.—The
size of the bougie is also to be increased as the resist-
ance to its passage becomes diminished.
  In those cases Avhere a bougie, even of the smallest
aize, cannot be passed, as likeAvise in those Avhich are
of such long standing as to preclude the hope of a re-
covery from its use, recourse is to be had to the appli-
cation of caustics.—For this purpose a piece of lunar
caustic is to be securely inserted into the extremity of
a common bougie,  and secured  from irritating  the
urethra, by being so enclosed as not  to project beyond
the  extremity  of the instrument; being  surrounded
every Avhere laterally by its  substance.—A common
bougie is now to dilate the canal of the urethra, to as-
certain the degree of the stricture, and to measure its
exact distance from the external orifice : this distance
being marked upon the armed bougie,  it is to be im-
mediately carried doAvn to the contracted part, and its
extremity suffered to remain  there, Avith a slight de-
gree of  pressure, for the space of about half a minute,
and then to be  withdrawn.—This is to be repeated
every second day ; and if there be more than one stric-
turc, they may thus be removed in succession. 
228
PARAPHYMOSJS.
                   PHYMOSIS
 Is a thickened and contracted state of the prepuce, b$
Avhich  it is prevented from being drawn behind the
glans penis.
                      CAUSES.
  The irritation produced by the matter of gonorrhaea ;
—acrid secretions  from the  glandulae odoriferae;—
sometimes it is connate ; at others it depends upon an
anasarcous SAvelling of the scrotum and penis.
                   TREATMENT.
  Where inflammation is present, topical bleeding by
leeches;—cold lotions applied to the parts ;—fomenta-
tions, if these are unsuccessful;—the injection, if prac-
ticable, of Avarm fluids betAveen the prepuce and  the
glans.
  If after inflammation has been by  these means re-
moved, and reduction by manual efforts still continues
impracticable, an operation is to be performed  for the
removal of the disease.  This is done by  means of a
sharp-pointed  knife concealed in a grooved director,
which  should  be insinuated betAveen the prepuce and
the glans,  until it has  reached  the corona glandis,
Avhen the knife should be  pushed forwards, and  the
prepuce divided at  the  dorsum : the wound is after-
wards to be dressed with simple dressings.
               PARAPHYMOSIS.
  Paraphymosis is a retraction  and swelling of the
prepuce, so as to produce a stricture behind the  glans
penis-—It is generally accompanied with much  swel-
ling and inflammation of the penis, which has in  many
instances terminated m mortification.- 
               - VNCER CF THE PENIS.          229

                      CAUSES.
  tt is induced by the same  causes as the preceding
disease.
                   TREATMENT.
  The same means  must be employed to reduce in-
flammation as recommended for phymosis ; and if, after
these, the parts still continue irreducible by pressure
Avith the  fingers simply, the prepuce is to be divided,
by making an incision  upon each side,  and not, as di-
rected for  phymosis, on the dorsum penis, which
Avould in this case endanger the division of the vessels
and nerves of the penis.
  After the  operation, an emollient cataplasm should
be laid upon the part, and the wound  aftenvards treat-
ed as a common sore.
           CANCER OF THE PENIS.
                     SYMPTOMS.
  The disease  usually begins  Avith  a small circum»
scribed tumor, or a Avarty excrescence, upon the glans
or prepuce of the penis,  and is frequently accompa-
nied Avith a natural phymosis, or the latter disease be-
comes a consequence of the former.—After the  expi-
ration of a shorter or longer time, inflammation super-
venes, ulceration takes place, a fetid ichor is discharg-
ed, a livid and truly cancerous fungus arises, attended
Avith an intolerable burning and lancmating pain.—The
glands in  the groin at length become affected, and if
the parts are not  removed  by  a timely operation,  it
usually, like all other  cancerous  diseases,  proves
fatal.
                        W 
230
HYOROCELE.
  If the prepuce  be the seat of the disease, circumci-
sion alone will be required.—If it be seated in the glan-
dular part, or should have extended to it, amputation of
the penis becomes necessary.
                 THE OPERATION.
  The sound parts are first to be compressed by a liga-
ture formed of narrow tape, as  recommended by Mr.
Hey; after  which a circular incision is  to  be  made
through the integuments, and the skin being drawn
back by an assistant, the body of the penis is to be di-
vided Avith one cut.—The vessels are noAV to be secur-
ed by ligature, and the integuments being br« ught for-
wards, are to be united with adhesive plaster, through
the middle of Avhich,by means of an opening previously
formed, a canula should be passed into the urethra, and
retained there by means of ligatures, connected Avith, a
bandage passed around the body.
                 HYDROCELE
  Is an accumulation of water within the cavity of the
tunica vaginalis of the testis, of the spermatic cord, or
in the cellular membrane of the scrotum.
I. Of hydrocele of the tunica vaginalis testis.
                    SYMPTOMS.
  An accumulation of a fluid is first perceived to com-
mence at the bottom of the scrotum, which gradually
increasing, the latter becomes enlarged and distended;
a distinct fluctuation is generally to be distinguished ;
—the tumor acquires a pyram dal shape ;—there is no
pain nor discolouration of the integuments; and upon 
HYDROCELE.                231
viewing the parts near to a strong light, a transparency
is observable.
                    DIAGNOSIS.
  It is distinguished from other diseases by its shape,
Avhicli  is constantly pyramidal,  except where the pa-
tient has had a  hernia, or where the disease has been
taken for hernia, and a truss has been Avorn, Avhen it
acquires an oblong  shape ;—by its transparency; yet
this criterion is rendered fallacious when the investing
membranes have previously undergone inflammatio n,
in Avhich case they become thickened and impermeable
to light;—by the fluctuation of the contained fluid ;—
by the tumor having first commenced at tne bottom of
the scrotum.
  From hernia—.By the tumor not dilating Avhen the
patient  coughs ;—by  the  tumor  in the  one  disease
commencing at the  top of the scrotum, in the other at
the bottom ;—by the facility of returning  the protrud-
ed intestine, in reducible hernia, into the abdomen.
  From disease of the testicle.—By  the Av:.m of disco-
louration and hardness ; and the absence of tl,at irregu-
larity to the touch possessed by scirrhus.
  From hematocele__By the colour and shape of the
tumor,  and  by that disease suddenly coming on and
being usually the consequence of accident.
  From anasarca of the scrotum.—By  the one being
clastic to the feel, the other cedematous;—the one py-
ramidal, the other irregularly shaped.
                   TREATMENT.
  At the  commencement  of the disease, and Avhen a
small quantity  of fluid only is collected, attempts may
be made to disperse it by cold and stimulating  applica- 
2-2
HYDROCELE.
tions ;  a solution of ammonia muriata, with the addi-
tion of vinegar and spirit.
R. Ammoniac murialx zss.     Take muriate of ammonia "ss,
   Aceti communis ?iij.         Common vinegar Ziij.
   Spiritus vini tenuioris,         Proof Spirits
   Aquxdistillatx, a a. 2iv.       Distilled water each ziv.
i'iatrlotio saepe applicanda.     Make a lotion, to be frequently
                              applied
  The lotio ammoniae muriatae is also a proper and  a
stronger application.
  In general, hoAvever, recourse is had to an operation
for the evacuation of the fluid.
                  THE OPERATION
  May  be either palliative, or radical.
   The palliative.—This is simply an evacuation of the
Avater, by means of a trochar.—The operator  having
grasped the back  part of the tumor with his left hand,
is to introduce a lancet-pointed trochar at the anterior
and inferior part of the scrotum ; and having pushed it
obliquely upvrards, the stilette is to be Avithdrawn, and
the canula  suffered  to remain until the whole of the
water has been evacuated; when the Avound is to be
covered with a piece of adhesive plaster, and the  scro-
tum suspended with a  suspensory bag, or the  T ban-
dage.
   Of the radical cure by injection.—The mode  of per-
forming the  radical cure of the hydrocele,  hoav most
frequently employed, is the  folloAving :
   After having evacuated the fluid,  as above directed
in the palliative operation, the  scrotum is to be again
filled Avith some stimulant liquor; diluted port-wine,
or a solution of vitriolated zinc,  are most proper for
the purpose.—It  is to be injected by means of an ela.s-
 jh- bottle  and  stop-cock,  previously adapted to the 
HYDROCELE.
canula of the trochar, and when the tumor has by this
means been made to regain its original size, the cock
is to be turned, and the loAver part of the syringe un-
screwed from its neck, Avhich should be suffered to re-
main Avithin the canula.—The patient will soon begin
to  complain of pain in the part, and colic pains across
the abdomen ; Avhen  these  occur,  and not until then,
the neck of the instrument is to be withdrawn from the
canula, the Avine or injected liquor discharged,  and the
patient should be conveyed to bed.
  In a feAV days the scrotum will again become tumid,
from an effusion of coagulable lymph caused by the in-
flammation of the tunic : this gradually Avearing aAvay,
a complete cure is effected.
II.  Hydrocele of the spermatic cord.
   This is a collection of Avater within the tunica vagi-
nalis of the spermatic cord, or in separate cells.
   It most frequently  occurs in infants.
   It is distinguished  from hydrocele of the tunica vagi-
nalis testis, by being situated above the testicle ; Avhich,
when the tumor is not large, may be distinctly felt be-
Ioav.
   From  anasarca of the  spermatic cord.—By the
smoothness, elasticity, and  fluctuation of the one tu-
mor, and the cedematous feel of the other.
   It is often with great difficulty  distinguished  from
                     09
hernia.—See Hernia.7 '
                     TREATMENT.
   Stimulant and astringent applications are generally
sufficient  to procure an absorption of the fluid ;—fric-
tion.
 in. Anasarca of the scrotum.
                        W  2 
234
VARICOCELE.
  An anasarcous state of the scrotum sometimes oc-
curs,  and increases to a  large size, Avithout  any con-
comitant hydropic affection of neighboring parts.
                     CAUSE.
  Enlargements of the glands in the groin, or the pres-
sure of a truss;—blows, or other injuries ;—the pres-
sure of the enlarged uterus in  pregnancy, or other
mechanical causes producing compression of the lym-
phatic vessels ;—inflammation of a peculiar kind,
                    DIAGNOSIS.
  The cedematous feel, and irregular shape, distin-
guish it  from hydrocele  of the tunica vaginalis; as
likeAvise from other diseases of the scrotum.
                   TREATMENT.
  Small incisions made with the point of a lancet, and
afterAvards  suspension, and compression of the scro-
tum, by means of a laced bag, or the T bandage.
       VARICOCELE, OR CIRCOCELE.
  Tumor produced by a varicose state of the  sperma-
tic vein, Avhich sometimes increases to a large size.—
It is  attended with no pain, and to the sight and feel
often seems composed  of hard  knotty  irregalarities-.
—sometimes it much resembles hernia and hydrocele,
for the former of which it is often mistaken.
                      CAUSE.
  Mechanical obstruction to the return of blood from
whatever cause ;—a  relaxed state of the coats of the
A7essels themselves.
                    DIAGNOSIS.
   The peculiar feel  and appearance, with  the  tumot 
HERNIA HUMORALIS.
235
receding in a recumbent position, distinguish it from
the complaints before mentioned; not so from hernia.—
See Hernia.'
                    TREATMENT.
  When the disease arises from temporary pressure
upon  the vessels in  their course, this, if practicable,
should be removed ; when from relaxation, the constant
use of a suspensory bandage,—astringent and stimu-
lant application to the part, as the lotion of ammonia
muriata Avith vinegar.
LOTIO AMMONIVE MURIATE LOTION  OF  MURIATE  OF
       CUM ACETO.         AMMONIA. WITH VINEGAR,:
       Pharm.  Chr-
R  Ammoniae muriaiae ?ss,     Tuke muriate of ammonia 5ss.
   Actti.                      Vinegar.
   Spiritus vinosi  rectificati,  Proof spirits, each Jfji.
    singulorum fljj.
Fiat lotio.                  Make a lotion.
  The cold bath ;—cold water frequently dashed upon
the perineum ;—a solution  of alum,—of vitriolated
zinc.
            HERNIA HUMORALIS.
                     SYMPTOMS.
  Pain and enlargement of the epididymis of the affect-
ed testicle; shooting pains along  the course of the
spermatic cord.—The  body  of the  testicle  next be-
comes affected ;  it sAvells, becomes hard and painful;
•—the scrotum becomes much enlarged a'd inflamed;
—there is a distressing pain in the loins ;—the system
at length becomes affected  with fever, quick; hard
pulse,, nausea, and vomiting. 
236
HERNIA HUMORALIS.
                     CAUSES.
  Inflammation of the testicle may be induced by any
of the common causes  of inflammation, but is most
frequently produced by irritation of the urethra, by the
matter of  gonorrhoea;—the improper  use of injec-
tions, or incautious introduction of a bougie.—It often
follows  a suppression of the  gonorrhceal  discharge
from cold;—sitting on wet grass is a frequent cause.
                   TREATMENT.
  The patient should be put upon a spare regimen,
should remain in  a recumbent posture, Avith the  part
suspended by  means  of the  bag-truss,  employed for
irreducible hernia.
 If the inflammatory symptoms run high, general bleed-
ing will be necessary; if not, local  bleeding by the
application  of leeches ;—saline purges ;—diaphore-
tics—antimonial s.
  Emetics  have been highly  extolled for their good ef-
fects in this disease;—sedative  and refrigerant  local
applications ; as,  aqua ammoniae acetatae,—a solution
of ammonia muriata,—aqua lithargyri acetati compo-
sita;  and at night a cold cataplasm made of linseed or
rye, with the addition of a solution of cerussa acetata.
.  After the inflammatory symptoms have  disappear-
ed, should the swelling remain,  and  assume a  scir-
rhous form, hydrargyrus muriatus ;—mercurial appli-
cations topically,  as the emplastrum hydrargyri;—oil-
skin ;—repeated emetics.
   Should suppuration ensue, poultices,—fomentations,
—early incision;—tonics, bark, Sec.
   A  fungus sometimes arises which assumes an ap-
pearance much resembling cancer.  It  should be re-
moved by the opiate caustic, or by excision. 
           SC-IRRHUS  OF THE TESTICLE,        .-v"

   CAI'STICUM OPIATUM.         OPIATE CAUSTIC.
      Pharm  Chir.
R Calcis cum kali puro Ziij.   Take common caustic Zjij-
   Opii pulveris 5SS-            Opium in powder Jss.
   Saponis mollis q. s.           Soft Soap q. s.
The caustic powder and the opium being mixed to-
  gether, are to be formed into a paste Avith the soap


       SCIRRHUS OF THE TESTICLE.
                      SYMPTOMS.
  An enlargement is first observed in the body of the
testicle,  which becomes  preternaturally hard, and gra-
dually increases in size.—An acute, intermitting,  lan-
cinating  pain  ensues ;  the colour of the integuments
becomes livid; the surface assumes an irregular knot-
ty appearance; and often adhesions take place of the
skin, forming indentations which must resemble cica-
trices.—Ulceration supervenes ; the edges of the ulcer
become  livid, sore,  hard, and retorted; fungous  ex-
crescences sprout forth; and if timely means are not
employed to prevent the extension of the disease, the
spermatic cord  partakes of the affection, becoming
hard and knotty.—Emaciation and hectic fever ensue.
                    DIAGNOSIS.
  From  hernia  humoralis.—The one is an acute,  the
other a chronic disease ;  the one enlarging gradually,
the other suddenly.—In the one the pain is  intermit-
tent, pungent, lancinating ; in the other constant.—In
hernia humoralis the surface of the testicle is smooth,
and of the usual colour of infiammation ; in scirrhus it
is livid, irregular, or knotty.
   From hydrocele.—By the  transparency of the tumor 
-238       SCIRRHUS  OF THE TESTICLE.

in that disease ; and other marks already mentioned.—
Vide Hydrocele.
                    PROGNOSIS
   Will ever be unfavourable ; more especially should
there be adhesions of the integuments, enlargement of
the  spermatic cord,  or of  the glands  immediately
within the pelvis, as discovered by pressure in the re-
cumbent position of the patient;—if hectic be  pre-
sent, or the patient be the subject of diseased viscera.
—The success of an  operation may be  predicted by
the absence  of the  abovt c'  cuinstances, and by the
youth and unimpaired constitution of the patient.
                    TREATMENT.
   After employing the  common remedies for the re-
moval of scirrhus (see Diseases of the Breast") Avithout
effect, the safety of the  patient demands the perform-
ance of an operation for the removal  ot the diseased
testicle.
       OF THE OPERATION FOR CASTRATION.
   The parts being shaved, and the patient laid  in the
position recommended in the  operation for hernia, an
incision is to be made through the integuments, from
the upper  part of the abdominal ring to the bottom of
the testicle.—By this incision  the external pudendal ar-
tery  will be  divided ; Avhich, if necessary, should be
immediately tied.—The fascia covering the cremaster
muscle will doav  be exposed ;—this being divided, the
spermatic vessels are  to be dissected from the vas de-
ferens, and  secured by ligature, the latter being ex-
cluded.—The cord is  noAV to be divided, at least  an
inch above the diseased  part; after which the testicle
is  to be removed from  its situation by a cautious dis-
section. 
HEMATOCELE.                239"
  The same ligature may be suffered to remain upon
the cord, or it may be slackened, and the. artery secur-
ed alone.
  After the operation, the edges of the wound are to
be brought together by means of the  interrupted su-
ture, and the part being covered with a soft compress,
is to be supported by the suspensory  bag, or T. ban-
dage.


                HEMATOCELE
  Is a tumor formed by an extravasation of blood in the
tunica vaginalis of the testicle, or of the spermatic cord ;
in the body of the testicle itself, or in the cellular mem-
brane of the scrotum.
                      CAUSE.
  Mechanical  injury ;—puncture ;—a rupture of ves-
sels after the sudden removal of the water in the ope-
ration for hydrocele ;—an atonic or relaxed state of the
vessels themselves.
                    diagnosis.
  The sudden appearance of the tumor ;—when arising
from external injury, the effect immediately following
the cause ;—.the livid discolouration of the scrotum ;—;
the swelling increasing from the bottom.
                   TREATMENT.
  Upon the first appearance of the tumor, astringents
may be employed to effect an absorption of the fluid ;—
should these be unsuccessful, recourse must be had to
an  operation,  Avhich  is performed as for hydrocele by
incision ;—after which, should an oozing of blood con-
tinue,  tonics and  astringents may be employed both
internally and  topically :—bark Avith vitriolic acid, as 
3*0                 THE PILES.
 recommended by medical writers  for the cure of pas-
 siA-e haemorrhages ;—locally, tincture of myrrh, &c—
 Vide Incised Wounds.
   If the effusion of blood be into the body of the testicle,
 castration will be necessary.—-See  Scirrhus of the Tes-
• *icle.%27 >


         DISEASES ABOUT THE ANUS.
       HEMORRHOIDS, OR THE PILES.
  The piles consist in a distention of the haemorrhoidal
veins ;  or in an effusion of blood into the surrounding
cellular substance, forming small tumors, either within
the anus or its verge, or sometimes producing one tu-
mid or varicose ring, by Avhich it is surrounded.
  In some cases they are attended with a discharge of
blood, particularly when the patient goes to stool, called
the bleeding or open pies ;—in others there is no dis-
charge, when they are denominated the blind piles.—
Sometimes they  are situated Avithin the gut, and ob-
tain the name of internal piles ;—but more frequently
they protrude beyond the anus, and are called external
piles.
                    SYMPTOMS.
 , The piles are  sometimes preceded by a  sense of
weight  in  the back, loins, and bottom of the belly, to-
gether with sickness at the stomach, and flatulency in
the bowels ;—on going to stool, a pungent pain is felt
in the fundament, and small tumors  are  perceived to
project beyond its verge.—If these break, a quantity of
blood is voided, and a considerable relief from pain N 
THE PILES.
41
obtained ;—if they continue unbroken, the patient ex-
periences great torture every time  he goes to stool,
and feels an inconvenience Avhen sitting doAvn upon any
hard seat.
                      CAUSES.
  Habitual costiveness;—hard riding ;—plethora;—ex-
cesses of various kinds ;—the suppression of long-ac-
customed evacuations ;—the use of aloetic purgatives ;
—the pressure of the enlarged uterus in pregnancy.
                    TREATMENT.
  The frequent Use of gentle laxatives ; as, sulphur,—
electuarium e senna,—cremor tartaris.
  When the tumors are attended Avith much pain and in-
flammation, leeches,—-puncture ;—refrigerant lotions ;
as, a solution of  cerussa acetata,—the aqua lithargyri
acetati composita, Avith the addition of opium.
  Emollient and anodyne ointments :
R. Unguenti spermatisceti 5j. Take Ointment of'spermaceti zi.
   Tincturae opii vinosae Jj-      Vinous tincture of opium Z\.
Fiat unguentum.             Make an  ointment
  Fomentations sometimes succeed better in allevi-
ating  pain  and inflammation than cold lotions ; as, the
fomentum  papaveris albi,—{omentum cicutae;
  Firm yet gentle pressure of each pile betAveen the
finger and thumb.
  In cases  where the tumors are relaxed and irritable,
fomentations of oak-bark,—of galls,  the frequent affu-
sion of cold Avaterj—or
X 
J4-
THE PILiiS
PASTA riPERIS C0MP0S1TA.        AVARDS PASTE.
       Pharm. Chir.
R. Piperis nigri,              Take Black pepper,
  Radicis inulac campan?:, aa    Elecampane root, each j^i,
            tb-i-
   Seminum  fccniculi  dulcis    Sweet fennel seed fan].

   Mellis despumati,           Clarified honey,
   Sacchari purificati, aaf^ij.    Purified sugar, each Jfjij.
The three first ingredients are to be finely  poAvdered
  and Avell mixed ;  after  Avhich  the honey and sugar,
  melted together over the fire and formed into a clear
  syrup, are to  be added, and the Avhole beaten into a
  mass.
  This is the celebrated Ward's Paste.—The  dose is
the size  of a nutmeg three times a day, Avith a glass of
water or Avhite wine.
  Balsam of copaiva taken on sugar, forty drops twice
a day.
  The folloAving ointment is also a good application :
■UNGUENTUM  GALL*  CAM-  CAMPHORATED GALL OINT-
 fhoeatum.  Pharm. Chir.            ment.
R. Gallarum  pulveris subtilis-  Take Galls finely powdered Zij.
            simi 2jij-
   Camphorae 5SS-              Camphor Jss.
   Adipis suillae preparatae Ij.   Hog's lard ?••
Fiat unguentum.              Make an ointment.
  In the open piles, should the attendant haemorrhage
be profuse, the injection if  within  the anus, or the ap-
plication if situated externally, 0?-. a solution of alum,
—of saccharum saturni,—fomentation of oak-bark.—
Pressure upon the bleeding veins, either by means of
a small  tube, covered with lint moistened with an as-
tringent fluid, or with a  sheep's  gut tied at one end,
and  after being introduced into the rectum, distended
Avith vinegar ar.d Avater. 
                  FISTULA rN A;iO,              '•-^'

  Extirpation by ligature or excision.
  Mr. Ware observes, that though there may be many
haemorrhoidal tumors, the pain is found usually to pro-
ceed from one only.   This is generally situated in the
centre, is hard, inflamed, of a darker colour, and more
prominent than the rest;—this he directs to be secured
by means of a forceps or tenaculum, and  then to be
removed Avith a pair of sharp scissars ;—cold brandy
and water, or a saturnine  solution, is aftenvards to be
applied.


               FISTULA'IN ANO.
  A sinuous ulcer in  the neighbourhood of the anus
and rectum.—It is either complete, incomplete, or
compound.
  A fistula  is termed complete  Avhen  there are two
openings; the one externally, the other communicating
with the rectum.—-The latter of these  is ascertained
to exist by an examination per rectum, and by the dis-
charge of faeces by  the sinus.
  An  incomplete fistula is where  the ulcer communi-
cates  Avith the  gut, but has  no external opening, or
Avhere  there is an  external opening, but no communi-
cation  Avith  the  rectum.—Its existence, in the firit
case, is ascertained by a discharge of matter by stoo;,
and by an examination per anum, by which the rir.uous
opening may often  be  discovered.  .
  The compound  fistula is Avhere the ulcer, besides
opening into the rectum, communicates Avith the blad-
der, as sheAvn by  the fetid  smeii and brown feculent
sediment in the urine;—by  air discharged from the
urethra, and by great  irritation  and dysuria__Within
'he vagina, in which case faeces arc discharged by both 
244
FISTULA IN ANO.
 orifices ;  or Avhen there is concomitant disease of the
 sacrum, coccyx, or contiguous parts.
                      CAUSES.
   Obstructions in  the  rectum from collections  of
 hardened faeces ;—condylomatous  excrescences ;-—
 piles ;—inflammation, and consequent abscess, induced
 by whatever cause ; by the application of cold,  as  sit-
 ting on wet grass ;—inflammation consequent on fever.
                    TREATMENT.
 Of the complete fistula.
            \  t. To reduce the sinus to the state of an
 Indications. J        healthy ^r—See Ulcer-
            j  ii. If that be impracticable, to reduce it
                    to the state of a simple wound.
                         i.
   By the  topical use of  stimuli;—injections of aqua
 calcis, of a solution of hydrargyrus muriatus,—of tinc-
 ture of cantharides.
   By invigorating the constitution by tonics ;—Peru-
 vian bark,—preparations of  steel,—pure air,—regular
 exercise, if practicable.
                         ii.
   By an operation performed in the folloAving manner:
   The  patient being placed Avith his  back toAvards a
window, Avhile his body leans upon a table or bed, the
finger covered with a bland oil is first to be introduced
at the rectum  ; after which, if  the fistula be complete,
a probe is to be passed along its course, until  its ex-
tremity reach  the internal opening, and touch the fin-
ger in the rectum ;—a probe pointed bistoury  is then
to be  passed  along  the  probe, and having  reached
the opening in the intestine, its handle is to be ele-
vated, and it;,  point depressed as much as possible by 
PROLAPSUS ANT.               245
the finger previously  introduced, and in this manner
gradually drawn out at the anus ;  by which means a
complete incision will  be  made of the intermediate
space between the sinus and the gut.
  If the fistula be incomplete, having no internal open-
ing, an artificial communication with the intestine must
be made ;—this is most easily effected by means of a
curved bistoury with a concealed point, which may be
pushed forwards through the coats of the gut, when the
instrument has reached the  extremity of the sinus.—
Mr. Hey.
  Should the matter have so insinuated itself along the
cellular membrane, as to cause several external  open-
ings ; they are to be successively dilated, until  all are
laid into one.
  The edges  of the wound are to be prevented from
uniting, and dressed with some stimulating application.
If any callous parts  are observable,  they  are  to be
touched, by means of a camel-hair pencil, with ammo-
nia muriata, or with hydrargyrus nitratus ruber.
  When an abscess is discovered in the neighborhood
of the anus, and is suspected to communicate with the
rectum, by a discharge of matter by  stool, suppuration
is to be accelerated by the  application of fomentations
and poultices, and an early opening should be made ;
by which means the sinus will be reduced to the first
of the above species*
               PROLAPSUS ANI.
  A protrusion of the rectum beyond the A'erge of the
Anus.
                       X2 
246
BROLAPoCS AN/.
                      CAUSES.
  Relaxation  of the parts;—irritation of the rectum
by the  use of aloetic purgatives ; worms ;—haemor-
rhoids ; violent exertion for the expulsion of hardened
faeces.
                   TREATMENT.
            r i. To replace the protruding- portion of
Indications. <        intestine.
            I n. To prevent its again prolapsing.
                       i.
  The  patient being laid  upon his  back, the finger
being covered with a piece of soft  linen, or a cone
formed of stiff paper, is to be introduced at the aper-
ture  in the prolapsed intestine, when gentle pressure
is to be made  until the whole be returned to its original
situation, successively pushing back the last protruded
portions;—after which a thick compress, so graduated
in size as to adapt  itself to the space between the nates,
and  steeped either in red Avine, or in some astringent
lotion, as a weak solution of alum, should be bound on
the part by means  of the T bandage.
   Should there be much inflammation,  fomentations,
or the vapor of hot water, should be applied to the parts
previous to any attempts at reduction.
                        ii.
  If the disease arise from debility, by the internal and
external administration of tonics and astringents ;—the
daily affusion  of cold water ;—lotions of a solution of
alum, of vitriolated zinc, or decoction of logwood ;—a
spirituous infusion of oak-bark with lime-water, as re
commended by Mr. Hey;—constant support by mean:;
of the befbre-deseribed bandage and comprc^c 
               IMPERFORATE  ANUS.           247
                                j>+y^ X+%
  Internally.—Alum,—zinc,—the pasta  piperis com-
posita, and other astringents.
  If from haemorrhoids,  removal of the cause by the
means already laid down.
  When from irritation of the  rectum by worm's, an-
thelmintics.—Temporary support by bandage.


    CONDYLOMATOUS EXCRESCENCES.
  Excrescences are sometimes formed about the anus,
which, from their figure, obtain the name of fici, aristae,
Sec.—They sometimes groAV within the gut itself, but
are oftener situated at the verge of the  anus.—They
vary in size, from that of ordinary warts to that of split
garden-beans.—They are also various in colour, figure,
and consistence.—Sometimes there is only one or two ;
generally, however, all the skin around the anus be-
comes covered Avith them.
                   TREATMENT.
   When they are soft, gentle escharotics will destroy
them, as ammonia muriata,  or pulvis  sabinae;—the
application  of tinctura ferri  muriati, by means of a
camel-hair pencil.—The harder kinds are to be remov-
 ed by lunar caustic, by ligature, or by excision.
          IMPERFORATE ANUS,
See wovks on diseases of children» 
248
SYPHILIS.
                   SYPHILIS.
  A disease  induced by the operation of a specific
poison ; imbibed most frequently during the act of co-
ition.
          I. Of primdry or local Symptoms,
                   CHANCRE.
  This is an ulcer induced by the immediate applica*
tion of the venereal poison.
                    CHARACTER.
  At  its  first appearance it resembles a common pim-
ple which has suppurated,, having in its centre a vesi-
cle or depression containing a small collection of mat-
ter ;—it soon increases, and becomes an ulcer, possess-
ing a  peculiar and characteristic appearance ;—its sur-
face is white or ash-coloured, irregular, concave ;—its
base hard, thickened, and  resembling the section of
a pea;—its edges are  prominent, thick, ragged, and
of an ash colour, and resemble a curtain hanging over
the hollow surface of the sore;—it is surrounded with
an areola or circumscribed inflammation, and differs
from other ulcers by its total want of disposition to
heal.
  The seat of chancre is various ;—the glans penis*—
the prepuce,—the fraenum,—the scrotum,—the mons
veneris.
  In  Avomen, the nymphae,—the clitoris,—the vagina*
■—the os uteri.
                   TREATMENT.
  When discovered 6oon after its formation, a chancre
may be removed by  the application of lunar caustic, or
by a lotion composed of a weak solution  of corrosiva
sublimate in spirit of wine, or the following: 
■VPHILI2.
249
 jERUCO CUM CALOMELANE.  ACETITE OF COPPER, WITS
       Pharm, Chir.         submuriate of misrcury.
R. JErugiuis preparatx,        Ttte prepared acetite of copper.
   Calomelanos,   singulorum  Submuriate of mercury, each
      partes aequales.           equal parts:
1'latpulvis subliLissimus.       Reduce  them to  a very fine
                             powder.
   In cases of longer  standing, it should  be treated
Avith mercurial dressings,—as ointments composed of
red precipitate, calomel, &c. or  the  unguentum hy-
drargyri, with the addition of opium, if the sore be
painful.
   Lotions of a solution of hydrargyrus  muriatus, and
of argentum nitratum, or of nitric acid.
   While attempts are made  by these  means to heal
the ulcer,  the constitution should ahvays be  secured
from the effects of absorption by  the use of mercury,
as directed for the general treatment of syphilis.
   In  irritable  constitutions,  it not unfrequently hap-
pens that chancre becomes phagedenic.—In this case
the mercury is highly prejudicial;—the external use
of opium,  Avith fomentation's, and a lotion composed of
a solution  of nitric  acid ;—fermenting  poultices, the
juice of oranges, See.  See Sloughing Ulcer.—The in-
ternal administration of Avine,—-opium in large  doses,
cicuta.
                      BUBO.
   An enlargement of an absorbent gland in the  groin,
owing to the absorption of tbe venereal virus ; general-
ly, though  not always, preceded by chancre.
                     SYMPTOMS.
   Pain in the groin, accompanied  Avith some degree of
hardness and sAvelling ; Avhich continuing to increase, a
tumor, equal in size to a pigeon's egg,  is formed,—It 
'250                  SYPHILIS.

proper measures are not speedily taken, it inflame^
becomes of a florid red, is attended with a more  acute
pain,  which suffers a  remarkable nocturnal exacerba-
tion,  and the progress from inflammation to suppura-
tion is usually very rapid.
  It is  distinguished from similar enlargements fron.
other causes,—by being confined to one gland,—by the
tendency to inflammation and  suppuration,—by  being
very generally preceded by chancre,—and by the  pecu-
liarity of the attendant pain.
  Like chancre in irritable or vitiated habits, it some-
times becomes phagedenic; in which case a formida-
ble sloughing ulcer is produced.
  When combined with scrofula, it is rendered  ex-
tremely  indolent; often  remaining a long  time,  and
enlarging to a great size without any disposition to sup-
puration.
                   TREATMENT.
In the uninfiamed state.
  Mercurial friction; lotions of a solution of hydrar-
gyrus muriatus.
In the vfinmed state.
  Leeches,—cold lotions,  as  aqua lithargyri acetati
composita; solution of ammonia muriata in Avater, with
the addition of spirit.
  Should these be unsuccessful,  fomentations and ca
taplasms.
  If suppuration ensue, the constant use of fomenta-
tions and poultices ;—an early evacuation of the matter
through a small opening.
  After inflammation has subsided, or after the process
of suppuration  has ceased, recourse must'again be had
to th, e use of :ne-cury. 
sypiiiLrs.
251
In the slouching state.                       £f
  See  Sloughing Chancre, and Phagedenic Ulcer.'
In the indolent or scirrhous state.
  If suppuration has  already commenced,  attempts
arc to be made to accelerate it by hot fomentations,—
warm  stimulating plasters.—Vide AbscessJ
  If the enlargement possess a scirrhous hardness,
and is indisposed to suppurate, fomentations of cicu-
ta,__sea-Avater,—sea bathing,—mercurial applications,
as the  emplastrum hydrargyri.—Vide Enlargements of
the Absorbent Glands, and Scrofula.
     n. Of secondary  or constitutional Symptoms.
  The constitution may become affected Avith syphilis,
either,
   1. By an absorption  of the virus, Avithout any evident
local effect having been first induced.
   2. In consequence of some primary local affection.
   3. From the application of the matter to some com-
 non sore or wound.
                 SORE  THROAT.
   An  inflammation and ulceration of  the throat, pro-
duced by  the absorption of the venereal virus, from
whatever source.—It  is usually the first effect produc-
ed in the constitution.—The time at which it makes its
appearance, after infection  has been received,  varies
 from five Aveeksto many months.
                     CHARACTER.
   Ulcers in the fauces, tonsils, uvula, or larynx, hav-
 ing the exact appearance of chancre before described ;
 __circular,—holloAv,—with ragged edges,—surround-
 ed Avith an areola.—Its surface is covered with a Avhite
 slough, and it is attended with nocturnal pain.—These
 characteristics,together with its having most generally 
252
SYPHILIS.
 been preceded by an obvious local affection, distinguish
 it from ulcerations of  the  throat arising from  other
 causes.
                   TREATMENT.
   The use  of mercury.—Locally, gargles of a  weak
 solution of hydrargyrus  muriatus ;—of  solutions  of
 the nitric and muriatic acids.—The fumes arising from
 the hydrargyrus  nitratus ruber, or hydrargyrus sulr
 phuratus ruber, thrown on hot iron, and  conveyed  to
 the throat by means of a fumigating machine.
           General Treatment of Syphilis.
   Mercury, so administered as to excite a disposition
 to salivation.— It may  be used  either externally, by
 friction Avith the unguentum hydrargyri upon the inside
 of the thigh, Avhich is decidedly the best and most cer-
 tain  way; or internally, by  the  use  of the pilula hy-
 drargyri, in pills of fiAre grains, to be  taken night and
 morning.
   In  the use  of mercury,  under whatever form, it
 will be prudent  to  begin with a small quantity, and to
 increase it  gradually, until the patient perceive a cop-
 perish taste in his mouth, fetor  of breath, and a  more
 than ordinary secretion  of saliva;  it should then be di-
 minished, and the quantity should afterwards be so re-
 gulated  as  constantly to preserve a slight salivation,
 without proceeding to any greater length.
  The operation of mercury is promoted by absti-
nence from  high-seasoned food; confining the diet to
meats of easy digestion,—to thin broths,'—preparations
 of sago^—barley. &c,—vegetables,—ripe fruits.
  Where great difficulty is found in producing the de-
 sired  effect, the  pediluvium, or warm bath,  are ser-
viceable. 
SYPHILITIC ERUPTION,
2.53
  Pfofuse purging is sometimes the effect of the ad-
ministration of mercury.—This should be checked by
the use of opium.
r  If too copious a salivation be produced, a gargle of
a Aveak solution of alum;—the internal use of sulphur,
—cold air.
■  The length of time required  for the cure of the dis-
 tse by this means, will depend upon  its inveteracy.
—In mild cases, from four to six weeks;—in cases of
■onger  standing,  and  of  a  more  confirmed nature,
eight or ten :—continuing the use of mercury for some
time after the disappearance of the disease.
  This mercurial  action, during the above period, is
to be kept up  Avith great  uniformity, until the symp-
toms wholly disappear, and  for a certain time  after,
which time experience alone can pronounce.
  Besides mercury, other remedies have been recom-
mended as specifics for the cure of the  venereal dis-
ease ; such are the  nitric or nitrous acid ;—the oxygen-
ated muriate of potash ;—decoctions of the lobelia, as-
tragalus, &c.—The efficacy of these has hitherto not
sufficiently been established.
                   ERUPTION.
  When syphilis attacks the skin, it usually assumes
the form of a  scaly eruption; and, according to Dr.
Willan, most  commonly of lepra vulgaris,—psoriasis
guttata,—psoriasis  diffusa,—psoriasis  gyrata.—The
blotches vary in size, from one sixth of an inch to the
extent of half a crown.—Their elevation above the cu-
ticle is sometimes scarcely evident; at others they
                        Y 
554
SYPHILITIC ULCERS.
are considerably protuberant.—The scale or scurf with
which they soon become covered, after  a short time
falls off, and is succeeded by another, which not unfre-
quently casting off deep, an ulcer is formed, Avhich
discharges an acrid fetid matter.   This sometimes ex
tends, and becomes a venereal herpes exedens.
  It is distinguished from every other eruption by its
peculiar copper colour,—by being generally accompa-
nied with nocturnal pains,—by not yielding to the usual
Temedies,—and by being ordinarily preceded by some
indisputable mark of the existence of syphilis.
                  TREATMENT.
  The use of mercury, as  before  directed; at  the
same time employing sudorifics,  as  antimony united
with calomel,  or pulvis ipecacuanhae compositus, with
decoctions of mezereon and sarsaparilla.
  Should ulceration take place, lotions of hydrargyrus
muriatus ;—the unguentum hydrargyri as a  common
dressing.
  Should there be great pain or irritation, the local ap-
plication of opium in form of lotion  or ointment; or
added to the unguentum  hydrargyri.
                    ULCERS.
  Sores appearing in  the legs and other parts of the
body, produced by the operation of the venereal poi-
son.
  They are the most irregular of all ulcers; seldom
forming one continued  ulceration, but generally com-
posed  of a number of small, distinct, circular exca-
vations, separated from each other by a thin bar of skin,
the edges of Avhich  are jagged, and project over the 
3YPHILITIC OZiENA.
adjacent sore,  It is generally surrounded by an areola
of a copper  colour, and often by a venereal eruption.
The discharge is at first a thin sanies ; aftenvards a ge-
latinous, whitish, yellow, or greenish matter.  It is ac-
companied Avith nocturnal pains,  and other character-
istics of the venereal disease,
                   TREATMENT.
  Gentle  salivation, continued until the ulcers have
completely healed, and other symptoms disappeared,
  The use of mercurial and other applications, as re»
commended for chancre.
                    OZtENA.
                    symptoms.
  After considerable previous deep-seated pain in the
nose, a discharge not purulent, but thin, sanious, fe-
tid, and intermixed Avith bloody sloughs.—It is attend-
ed with a nocturnal exacerbation of pain, and is gene-
rally accompanied with some other obvious  syphilitic
affection.—Caries  of the  ossa  nasi is sometimes the
cause, sometimes the consequence, of the disease.—It
not unfrequently produces fistula lachrymalis.
                   TREATMENT.
  Besides the use of mercury, lotions  injected into the
nose by means of a syringe, formed of a solution of hy-
drargyrus muriatus in  lime-Avater, or a dilute solution
of nitric acid.
  Fumigations, of ^Ethiops mineral, cinnabar, &c. as re*
commended for ulceration of the throat. 
256
PAINS.
                  OPHTHALMIA.
   A severe inflammation of the eye is sometimes the
 consequence of the venereal  taint,  and if proper re-
 medies are not duly administered, usually termuiates in
 an opacity of the cornea.—It  is distinguished by not
 giving way to the use of common remedies ;—by being
 attended by nocturnal pain;—by  the  eye being less
 sensible to impressions of light;—by the disease hav-
 ing been preceded,  or being  accompanied, by other
 marks of syphilis.
                    TREATMENT.
   If much inflammation be present, this should be di-
 minished by the application of leeches  to the temples,
 —•sedative collyria,  &c. as in common ophthalmia.—
 After which, the internal use of hydrargyrus muriatus,
 and mercurial friction, as before directed,—and  of a
 watery or vinous solution of opium,  applied topically.


                       PAINS.
,   When the constituion has long been contaminated by
\ the venereal poison, distressing pains take place in the
 bones of different parts of the body; more especially
 of the leg, the arms, and head.
   They are distinguished from pains induced by other
 causes ; by being attended Avith a nocturnal exacerba-
 tion ;—by being seated, Avhen occurring in the  extre-
 mities, hi the middle of cylindrical bones;—by being
 very  generally preceded  or accompanied Avith other
 symptoms of the venereal disease.
                    TREATMENT.
   The long-continued u.se of  mercury, as before di-
 rected. 
NODS.
25?
  Sudorifics ; the  pulvis ipecacuanhae compositus,—
antimony unitedVith opium,—calomel united with an-
timony ;—at the same time using decoctions of meze-
reon,—sarsaparilla,—guaiacum.
  The Avarm bath ;—the occasional use of opium.
                      NODE.
   Its seat is most frequently on the cylindrical bones ;
 and on the bones of the cranium.
                    SYMPTOMS.
   After  deep-seated, obtuse, and distressing pain, at-
 tended with a nightly exacerbation, a prominent rising
 upon the  surface of a bone; hard to the touch;—-
 sometimes  insensible, and  unattended by discoloura-
 tion of the integuments;—at others  considerably in-
 flamed and sore.
   Suppuration sometimes takes place within the bone ;
apertures are formed by the ulcerative process, through
which the fluid escapes;—the tumor, before hard,  is
noAV soft to the touch, and  increased in size, and the
fluctuation of a fluid between the periosteum and the
bone is perceptible.—The integuments at length burst,
when, upon examination, holes are often found com-
municating with the interior part of the enlarged por-
tion of the bone, Avhich is holloAv, and surrounded with
a thick deposit of oasific matter, or exostosis.
                   TREATMENT.
  If there be much inflammation and pain,  occasional
bleeding by leeches, and blisters, will  be useful.—-See
Infiammation of Bone.  ^'
Y2 
.5*       AMPUTATION  OF THE FINGERS.

  If it be insensible to the touch, the emplastrum hy-
drargyri.
  Should suppuration ensue, a free incision,—and af-
tenvards the use of mercurial topics.
  Mercury is to be gradually introduced into the sys.-
tem by friction, and the mercurial action kept up for
some time  after the total disappearance of the symp-
toms, as before directed ; at the same time the patient
must constantly take the decoctum sarsaparillae, or the
decoctum sarsaparillae compositum.
                AMPUTATION.
  Amputation becomes necessary Avhen a member has
been rendered useless by disease, or Avhen the consti-
tution is in danger of suffering by its longer continu-
ance.
  The diseases most frequently  requiring this opera-
tion are, extensive contusions and lacerations ;—incur-
able ulcers ;—haemorrhage from vessels Avhich cannot
be secured by ligature, as the posterior tibial artery;—
extensive mortifications;—gun-shot wounds of joints,
or compound fracture by gun-shot;—scrofulous affec-
tions of the joints ;—caries of bones ;—bad fractures,
              OF THE FINGERS.
At the joint connected with the metacarpal bone.
  1. An incision is to be made on each side, betAveen
the fingers  and extended obliquely upwards to the
joint. 
           AMPUTATION OF THE TARSUS.        259

  2. A circular  one through  the  remaining integu-
ments and muscles.
  3. A cautious  separation of the finger at the joint
  4. The  fingers, before contiguous to that remoA'ed,
are  to be brought together and secured by  bandage ;
by  which means the haemorrhage will  be restrained,
union by the first intention will be  effected, and de-
formity in great measure prevented.
At  the lower joints.
  A circular incision  is to be made beloAV the joint,
and the integuments being retracted, the  operation is
to be finished as in amputation at the wrist.
               AT THE WRIST.
  The tournequet  being  properly applied,  incision
is to be made,
  1st, Through the integuments, about one inch be-
low the joint, after which they are to be drawn up by an
assistant.
  2dly, Through  the tendons and into the joint; be-
ginning the incision from the side connected with the
radius.
  3dly, The arteries are to be secured by ligature, and
the integuments brought together, and united by ad-
hesive plaster.
               OF THE TARSUS.
  The tournequet being applied, as in all amputations,
in the lower extremity (see the following), a circular
incision is to be made opposite the junction of the tar- 
260         AMPUTATION OF  THE  THICK.

sal and metatarsal bones ; and the divided integuments
are to be draAvn up by an assistant.—The second inci-
sion should be  through the tendons  and muscles.—
The tarsal bones are now to be carefully cleared from
any adhering muscular  substance, and to be  divided
with the saAv ;  saving as much of the foot as the dis-
ease for which the operation is performed will admit
of.—After the arteries have been secured, the integu-
ments  are  to  be brought over the extremity of the
bones,  and united by the first intention.
               OF  THE  THIGH.
  The most proper part for the application of the tour-
nequet in this, and in all other amputations of the Ioav-
er extremity, is about the middle of the thigh,  where
the artery in its course passes  near to the bone__The
pad should be  placed  immediately above the vessel,
and firmly secured in its situation by tightening the
screw on the other side of the limb.
  After this has  been adjusted, the limb being sup-
ported by an assistant, a circular incision  should be
made through the  integuments, immediately above
the knee-joint; and  any  adhesions  that may impede
their retraction having been separated, they are to be
drawn up as high as possible, Avhen a second incision
should sever either the whole  of the  muscles  of the
thigh,  or the loose muscles only; leaving those attach-
ed to the bone to be divided by a third.
  The bone noAV  exposed, is to be cleared of its peri-
osteum, and any portions of muscle that may still ad-
here ; and then to be divided witb the saw, at that part 
             AMPUTATION  OF THE LEG.         261

 n here it is connected with the retracted integuments :
 should any spicula or projecting points remain,  these
 are to be removed.
  The next  step is to secure the arteries ;  and this
 should be carefully done by means of the tenaculum
 and  ligature.—A flannel or linen roller is then  to be
 passed around the thigh, to prevent the retraction of
 the muscles; after which the integuments are to be
 brought together, and  preserved in contact by means
 of adhesive  straps; suffering the  ligatures  to  hang
 from one corner of the wound.
  The stump  is to be covered  with  a pledget of soft
 tow or lint, which should be preserved in its situation
 by a broad piece of linen or a laced  stocking.
  The patient may now be conveyed to bed; where the
 stump should be laid upon a soft pillow, and  protect-
 ed from the bed-clothes by a hooped frame.—It will al-
 so be proper to administer an opiate, and to suffer the
 tournequet to remain loosely attached to the limb, as
a means of speedily restraining any haemorrhage that
 may accidentally occur.
  At the expiration of a  Aveek the dressings  may be
removed, and the ligatures A-vithdrawn.
                 OF THE LEG.
  The tournequet being properly applied, and the leg
supported as before directed, an incision is to be made
through the integuments, about six inches beloAV the
knee ; and  when the adhesions which connect them to
the fore part of the tibia and fibula  have been separate
ed, they are to be draAA'n up by an assistant. 
262  AMPUTATION  AT THE SHOULDER JOINT.

  The muscles of  the leg are next to be completely
divided by a circular incision, close to the retracted in-
teguments.
  The object is now to divide all that connecting sub-
stance  betAveen the  tAvo bones: this is to be done by
means of a sharp-pointed double-edged knife made for
this  purpose.—After  which both the bones are to be
saAvn through, by the  same action of the saAv, at a dis-
tance from the knee equal to the breadth  of the hand,
—The remaining part of the operation will be exactly
similar to the before described.
              OF THE HUMERUS.
  In amputations of the superior  extremity, the most
convenient part for the application of the tournequet
is about midAvay betAveen the shoulder and the elboAV
pint; where it is to be adjusted as before described,
with the pad over the principal artery.
  The first incision is to be begun about an inch above
the joint, and the operation concluded precisely as in
the thigh.


              OF THE FORE-ARM.
  As in the leg- before the knee.


         AT  THE SHOULDER JOINT.
  The  patient is to be so placed, that the axilla may
be clearly exposed to the vieAV of  the operator, Avho is
first to make an incision in the course of the axillary 
      AMPUTATION AT THE SHOULDER JOINT.   263

artery, and having exposed the vessel, is carefully \o
dissect it from the vein and the plexus of nerves  with
which ii  is accompanied, and secure it by ligature.
  A second incision  is  then to  be carried obliquely
through  the  deltoid  muscle,  beginning about four
inches down the arm  on the outside,  and ext mding it
upAvards  to the ligature on the artery.
  The third incision divides the  remaining  muscles,
the capsular ligament,  and separates  the  humerus'
from its connexions.—It is to be begun  close  to  the
joint, immediately beneath the ligature, and carried in
a circular direction around the arm.
  The flap, previously formed in the deltoid muscle,
is now co be extended over the surface of the Avound ;
and union by the first intention is to be effected by  the
aid of the  interrupted suture* adhesive plaster, and
proper bandages. 
 
A
        GLOSSARY,

               OR

EXPLANATION  OF TERMS.
                        A.
Abscess (Abscessus, us, m. from abs, and cedo, to re-
  tire).  A collection of pus in the cellular or adipose
  structure.
Amaurosis (Amaurosis, is, f. from ccfx,ccvga<rt<;,  obscu-
  rity).  A loss of sight Avithout any visible injury to
  the eye.
Anasarca (Anasarca, ae, f. from avce,  along, and e*~f f,
  the flesh).  Dropsy of the cellular  membrane.
Anchylosis  (Anchylosis,  is,  f, from ay^vXe^xt, to
  bend.  A stiff joint.
Aneurism (Aneurisma, atis, n. from uvvgwa, to di-
  late).  A preternatural dilatation of an artery.
Anthrax (Anthrax, acis, m. ccvtig<e|, a burning coal).
  A carbuncle.
Antiphlogistics  (Antiphlogistica remedia, from  «»7/,
  against, and  0Aoy«e-<s, inflammation).   A term ap-
  plied to those medicines, plans  of diet, and  other
  circumstances, which tend to oppose inflammation.
Aphthe (Aphthae, arum, f.  from cc$6ki, the thrush),
  The thrush.
                         Z 
366
GLOSSARY.
                        B.
Bronchocele (Bronchocele, es, f. from j3fay#«s, the
  Avindpipe, and xsjAjj, a tumor).   The  Derbyshire
  neck;—a tumor formed by  an enlargement of the
  thyroid gland.
Bronchotomy (Bronchotomia,  ae. f. from /tyay^os, the
  windpipe, and re^va, to cut).  The opening of the
  Avindpipe, or trachea.
Bubo (Bubo, onis, m. from (iovSuv,  the  groin; be-
  cause they most frequently happen in that part).  A
  sAvelling of a lymphatic gland.
Bubonocele  (Bubonocele,  es,  f. from /3a«f«y, the
  groin,  and xjjAjj, a tumor).  An inguinal rupture.

                        C.
Calculus (Calculus, i,  m).  A stone.  Concretions in
  the urinary  bladder, gall-bladder, &c.  are  termed
  calculi.
Cancer  (Cancer, eris, m. from the term being ap-
  plied  by the  ancients  to tumors accompanied with
  large blue veins,  resembling crabs-claws).   A pain-
  ful, hard,  indolent tumor of a part which terminates
  in the foulest ulcer.
Caries (Caries, ei, f.).  Rottenness or ulceration of the
  bones.
Cataract (Cataracta, ae. f. from xxrageivo-u, to confound
  or disturb ; because the sense of vision  is confound-
  ed, if not destroyed).  An opacity of the crystalline
  lens that obscures the sight.
Cicatrix  (Cicatrix, icis, f. from cicatrico, to skin).  A
  scar.
Circoeele (Circoeele, es, f. from Ktpo-og,  varix, or a
  dilatation of a vein,  and «j?a^, a tumor).  A swelling 
GLOSSARY.                267
   of the testicle and spermatic  chord from a Aaricose
   state of the veins.
 Condyloma (Condyloma, atis, n. from KovfvXog, a tu-
   bercle or knot).  Wart-like  excrescences,  Avhich
   appear about the anus and pudenda of both sexes.

                         D.

 Diagnosis (Diagnosis, is, f. from Staymae-tca, to dis-
   cern).  The science Avhich points out the  signs by
   Avhich a disease  may be distinguished.
 Diathesis (Diathesis, is,  from  2iet6yfit,  to dispose).
   Any particular state of the  body: thus, in a putrid
   fever there is a putrid tendency, in inflammatory fe-
   ver an inflammatory tendency.
 Discutients (Discutientia; from  discutio,  to shake in
   pieces).  Substances  which possess a poAver of re-
   pelling or resolving tumors.
 Dysuria (Dysuria, ae. f. from ^1/5, difficult, and apat,
   urine.  Difficulty and  pain in discharging urine.

                         E.
 Emollients  (Emollientia;   from  emollio,   to  soften).
   Those  substances  which possess a poAver of relax-
   ing the living animal  fibre, without producing that
   effect from any mechanical  action.
 Emphysema (Emphysema,  atis,  n. from  tf*.<pvo-»», to
   inflate).   Air in the cellular membrane.
 Empyema (Empyema,  atis,  n.  from  tv, Avithin, and
 -xvci, pus).   A collection of  pus in the cavity of the
 thorax.
Ent'erocele  (Enterocele, es, f. from  tvlepov, an intes-
  tine, and x>jAjj, a tumor). A rupture formed by a pro-
   trusion of intestine. 
268
GLOSSARY-.
Entero-epiplocele (from erftpcv, an intestine, nwrXoov,
  the epiploon, and xjjAsj, a tumor).  A rupture form-
  ed by the protrusion of part of an intestine, Avitli a
  portion of the epiploon.
Enuresis (Enuresis, is, f. from evagea, to make Avater).
  An involuntary flow of urine.
Epiplocele   (Epiplocele, es, f.  from  e7rt7rXeov,   the
  omentum, and xjjAjj,  a tumor).  An omental hernia.
Epistaxis (Epistaxis,  is,  f. from  eTigct^M, to distil
  from).  Bleeding at  the nose.
Escharotics (Escharotica ; from zo-xa.%«_•, to scab over).
  Caustics.  Those substances Avhich possess a poAver
  of destroying the texture of the solids of the animal
  body, to Avhicli they are directly applied.
Excrescence (Excrescentia, ae, f. from excresco, to
  grow).  Any preternatural formation of flesh.
Exomphalos (Exomphalus, i, m. from  «|, out,  and
  o/upuXos,  the navel).  An umbilical hernia.
Exostosis (Exos  osis,  is, f. from  e|,  and oc-7«#»,  a
  bone).  A morbid enlargement or hard tumor  of  a
  bone.

                        F.

Fistula (Fistula,  ae.  f. quasi fusula; from fundo, to
  pour out). A long and sinuous ulcer that has anar-
  roAv  opening, and  sometimes  leads to a larger ca-
  vity.
Fracture (Fractura,  ae, f. from frango, to break).  A
  solution of a bone into two or more fragments.
Fungus  (Fungus, i, m.).  Proud   flesh.  A morbid
  growth of flesh upon an ulcer.
Furunculus  (Furunculus, i,m.fvom furo, to rage. So
  named from its heat and inflammation before it sup- 
GLOSSARY
259
   purates). An inflammatory tumor of a subcutaneous
   gland.

                         G
 Ganglion (Ganglion, i,n. from yuvyXiov, a knot).  An
   encysted tumor formed in the sheath of a tendon-,
   and containing a fluid like the white of an egg.
 Gangrene (Gangraena, ae. f. from yaiyu, to feed upon).
   A mortification of any part of the  body, before en-
   dowed Avith vitality.
 Gonorrhea (Gonorrhoea, ae. f. from yovsj, semen, and
   ptu, to floAV ; from an erroneous supposition of the
   ancients that it Avas a seminal flux). A preternatu-
   ral flux from the urethra or vagina.
 Granulation.  A healthy groAvth of flesh on a sore.

                        H.

 Hematocele, Haematocele, es,  f. from at/tec,  blood,
   and  x.y\i), a tumor).  A collection  of blood in the
   tunica vaginalis, or in the cellular membrane of the
   scrotum.
 Hemorrhage (Haemorrhagia, ae.f.from aipx,blood,and
   pvyvvpi, to break out).  A bleeding or rupture of a
   blood-vessel, the blood floAving therefrom.
 Hemorrhois (Haemorrhois, idis, f.  from  atpopfote, a
   flux of blood).  The piles.
Hectic (from *f/$, habit).  A term applied to a fever
  that  is  attended with evening exacerbations,  and
  slight remissions in the morning, and Avhich reduces
  the strength and causes the body to waste.
Hernia (Hernia, ae. f. from J/>ves, a branch,  because it
  protrudes forwards).  A rupture or protusion of a
                       Z2 
270
GLOSSARY,
  part of any viscus from one of the circumscribed ca-
  vities of the body.
Hernia  congenita (so called, because  it is as it Avcre
  born Avith the person.  A species of hernia, wherein
  the intestine or omentum adheres to the testicle.
Hordeolum (Hordeolum, i. n. diminutive of hordeum\
  A tumor in the margin of the eye-lid, resembling in
  some respect a barley-corn.
Hydarthrus (Hydarthrus, i, in. from 6S'up, water, and
  apSpov,  a joint).   A Avhite swelling of a joint.
Hydrocele (Hydrocele, es,  f. from vdap, Avater, xyXi,
  a tumor).  Dropsy of the scrotum.
Hydrothorax (Hydrothorax, acis, m.from v$ap, water,
  andS^f-f, the chest).  Dropsy of the chest.

                        I.

Indication (Indicatio, onis, f.  from indieo, to  shovv).
  That which demonstrates in a disease what ought to
  be done.
Infiammation (Inflammatio, onis,  f. from infiammo, to
  burn).  A disease characterized by increased heat,
  redness, and tumefaction.
Ischuria  (Ischuria,  ae, f. from t<?%a, to restrain, and
  apov, the urine).   A suppression of urine
Lithotomy (Lithotomia,from \160s, a stone, and tciuv*>,
  to cut).  The operation of cutting a stone from the
  bladder.

                         M.

 Mastodynia (Mastodyniaj se>  f, from /*»?♦$; a breast, 
GLOSSARY.
27 X
  and tSvvy),  pain)!  Inflammation  of  the breast of
  Avomen.
Maturation  (Maturatio, onis, f, from maturo, to make
  ripe).  The process  Avhich succeeds inflammation,
  by Avhich pus is collected into an abscess.
Meliceris (Meliceris, idis, f.  from  /tceAf, honey, and
xjjg«5) wax).   A tumor that contains a  substance like
  honey.
Mollifies ossium  (Mollities, ei, f. from mollis, soft). A
  disease of the bones, wherein they can be bent with-
  out fracturing them.

                         N

Nxvi materni (Naevus, i. m. Heb.).  Mother's marks,
Necrosis (Necrosis, is, f. from vexpoa, to destroy). The
  dry gangrene.   A species of mortification, in which
  the parts become dry, insensible, and black, without
  any previous inflammation.

                        O.

Oedema (QEdema, atis,  n.  from otS'ea, to  swell).   A
  dropsical swelling of the flesh.
Ophthalmia (Ophthalmia, ae,  f. from  otpeccXfio?,  the
  eye).   Inflammation of the eye.
Ozena (Ozaena,  ae, f. from *£#, to smell).  A malig-
  nant ulcer in the nostrils.

                         P.

Paracentesis (Paracentesis, is, f. from ts-ccpciictvrea, to
  pierce through). The operation of tapping or draw-
   ing Avater from the cavities of the body.
Paraphymosis (Paraphymosis,  is. f.  from v*p*, about, 
2/2
GLOSSARY.
  and  (ptfiaa, to bend).  A permanent contraction of
  the foreskin behind the glans penis, so as to denu-
  date the glans penis and strangulate it.
Paronychia (Paronychia, ae. f. from  _-«/>„, about, and
  ev&l, the nail).  A whitloe, orAvhitloAV.
Pathognomic  (Pathognomicus;  from •ar„0«5,  a dis-
  ease, and ytv6>o-K6>, to knoAv).  Pathognomonic ; a
  term given to those symptoms which  are peculiar
  to a disease.
Pernio (Pernio, onis, m.\   A chilblain.
Phlegmon (Phlegmone, es, f, from  <px.eya>, to burn).
  An inflammatory tumor..
Phagedenic (Phagedenicus; from QctyiSctivx,, an ulcer
  that eats or corrodes rapidly)r  A foul ulcer, that
  spreads rapidly.
Phymosis (Phymosis, is, f. from <ptp,oa>, to  bend).  A
  contraction of the foreskin, so that it cannot be drawn
  back over the glans penis.
Polypus  (Polypus, i, vel podis, m. from -zroXvs, many,
  and ar«s, afoot; from its sending off many ramifica-
  tions, like  the  legs  of a polypus).  A fleshy sub-
  stance that grows in the nose and other parts.
Prognosis (Prognosis,  is,  f. from srpo,  before, and
  ytvaTKu, to know).  The judgment of the event of
  a disease by particular symptoms.
Prolapsus (Prolapsus,  us, m.) A protrusion or falling
  doAvn of any part within  itself, as  when the lower
  bowel falls  down, and is inverted by passing through
  a part of its own canal.
Pterygium  (Pterygium, i. n. _-7*/)t;£, a wing).  An
  excrescence growing upon the inner canthus of the
  eye. 
GLOSSARY.
273
Pus (Pus, uris, n. pi. pura).   Matter.  A secretion
  from ulcers and into abscesses, that resembles cream
  in appearance.

                        R.

RanUla (Ranula, ae, f. from rana, a frog).   A tumor
  under the tongue, supposed by the ancients to make
  the person croak like a frog.

                        S.

Sarcoma (Sarcoma, atis,n. from c-aaf, flesh).  A fleshy
  excrescence.
Scirrhus (Scirrhus, i.  m. from c-^ippoe, a primitive in
  Greek).   A conversion of a  part into a hard indolent
  tumor, not readily suppurating.
Scrofula  (Scrofula, ae,  f. from scrofula, a swine;  be-
  cause this animal is  said to be much subject to a
  similar  disorder).  The  king's evil.   A disease of
  the lymphatic glands.
Sedatives (Sedativa; from  sedo, to ease or assuage)1.
  Those  medicines which diminish the animal energy
  Avithout destroying life.
Specifics.  Such remedies as have an infallible efficacy
  in the cure of disorders.
Sphacelus (Sphacelus, i, m.).   A mortification of  any
  part.
Steatoma (Steatoma, atis, n. from sexp, suet).  An en-
  cysted tumor, the contents of which are like suet.
Stimulants (Stimulantia ;  from stimulo, to stir  up).
  Medicines which excite the  animal energy.
Strangury (Stranguria, ae, f. from s-p«y|, a drop, and
  xpov, urine).  A difficulty of making Avater. 
274
GLOSSARY
Styptics (Styptica,  ae, f. ?v<po,  to astringe).   Thov;
  substances which possess a power of stopping hae-
  morrhages.
Suppuration (Suppuratio,  onis, f. from suppuro, to
  suppurate).   The formation of pus in phlegmonous
  tumors.
Sympathy  (from rvftwotrx6'' to suffer together, to
  sympathize).  Consent of parts^
Syphilis (Syphilis ;  from Syphilis, the name of a shep-
  herd who fed the flocks of King Alcithous, Avho,
  proud  of their  number and  beauty,  insulted the
  Sun ; as a punishment for Avhich, fable relates, that
  this disease was sent on the earth ; or from <rt<p\o$,
  filthy).  The venereal disease.

                        T.

Tetanus  (Tetanus,  i,  m. from retvu, to stretch).
  Spasm, with rigidity of the  part under the spasm.
Trichiasis  (Trichiasis, is,  f.  from rpt^, a hair).  A
  disease  of the eyelashes, in which they  are turned
  inwards.

                        U.

Ulcer (Ulcus, eris, n. from tA*o?, a sore).  A purulent
  solution of continuity of the soft parts of an animal
  body.

                        V.

Varicocele (Varicocele, es,  f.  from varix, a distended
  vein, and xt)Xv, a tumor).   A swelling of the veins
  of the scrotum or spermatic cord. 
                     GLOSSARY.                  275

Vesicatories   (Vesicatoria;  from  vesica, a  bladder,
  because they  raise a bladder).   Substances which
  increase the action of  the vessels in those  parts of
  the surface of the body to Avhich they are  applied,
  and cause a vesication or blister.
Vomica (Vomica, ae,  f.).  An abscess : generally ap-
  plied to suppuration of the lungs. 
 
INDEX.
                       Page
            A.

Abscess      -       -    8
-------of the eye   -    125
      - of the lungs     160
      - of the bones     188
Absorbent glands, enlarge-
  ment of     -     -     82
Adder, bite of       -      32
Adhesion      -     -      7
iErugo cum calomelane  249
Alimentary canal, diseases
  of                   153
Aluminous cataplasm     116
Amaurosis    -          117
Amputation       -      258
----------of the penis  230
———---- of the fingers 258
----------at the wrist  259
  ■     — of the tarsus  ib.
----------of the thigh  260
----------of the leg    261
——------of the hume-
  rus      -       -    262
-----■----of the fore-
  arm       -       -    262
----------of the shoul-
  der joint      -      262
Anasarca of the scrotum 233
Ancle, dislocation of    187
Aneurism, operation for    86
---------. popliteal, ope-
  ration for       -        87
.--------, diffused        88
—____.. • false     -     lb.
                        fag*
 Anthrax                 71
 Antrum of Highmore, col-
   lection of matter in    143
 ———- of H/ghmore, can-
   cer of      -    -      ib.
 -------of Highmore, per-
  foration of      -       ib.
 \phtha      -    -      147
 Application of leeches     45
 ----------of the tourne-
  quet             -     15
——------of a truss      93
Aqua cupri vitriolati cam-
  phorata     -     -     53
Arsenicum antimonii       61
B.
Benign ulcer	49
Bile of the viper	32
----of the rattlesnake	ib.
----of the adder	ib.
----of insects	33
—— of serpents	34
Bites of rabid animals	31
Bladder, stone in	205
Bleeding piles	240
Blind piles	ib.
Blister issue	47
Bin, )rl. letting-	40
	
arm	ib.
------in the neck   41
------in the tem-
poral artery       -      42
Aa 
                         IND

                        rage  1
Bloou-lettmg, in the foot   42
-----------, inflammation
  of the integuments from 43
———-----, inflammation
  of the absorbents from   44
-----------, inflammation
  of the subjacent fascia
  from      -       -     ib.
Boil      -      -        69
Bones, diseases of       184
-----, inflammation of    ib.
———, abscess of        188
———, mortification of   189
Bougie, introduction  of   227
Brain,  injuries  of, from
  external violence       103
    -, concussion of       ib.
    -, compression of    105
——--, consequences of in-
  juries to    -    -    108
■■      inflammation of   110
Breast,  inflammation of   164
——, cancer of         ib.
     . , extirpation of    167
Bronchocele      -       79
Bronchotomy     -       159
Bubo      -       •     249
Burns      -      *      64

            C.

Calculus     -     -    205
  .  .  ... of the  salivary
  glands     -     -    151
-------in the kidney    205
Cancer      -       -     82
——.— of the eye        131
  ,  ■- of the antrum of
  Highmore       -      143
.------of the lip     -    146
------of the tongue     150
.  i     of the breast      164
------of the penis       229
Cancerous ulcer     •    60
Carbuncle     -     •     71
Catiesof the spine       191
Carnatic snake pill        36
'EX.

                         Vage
 Cartilaginous substances
    within the capsular lig-
    aments    -     -     173
 Castration       -       238
 Cataplasma effervescens   12
 ---------  dauci    -    57
 ---------natri vitriolati 115
 ---------aluminis      116
 ---------rosx     -     ib.
 Cataract      -    -    118
 Caustic bougie, arming of 227
 Causticum  opiatum      237
 Ceratum salis cornu cervi  60
 Chancre      -    -     248
 Charcoal, cataplasm of    12
 Chilblain       -    -    70
 Circoeele    -     -     234
 Clavicle, dislocation of   181
 Collyrium lithargyri acetati
    camphoratum    •    114
 --------opiatum     -   115
 Compound fracture      202
 Compression of the brain 103
 Concretion of the eyelids 129
 Concussion of the brain   103
 Condylomatous  excres-
    cences     -     -     247
 Constitutional vitiated ul-
    cers      -      -     57
 ------——- symptoms
    of syphilis      -      251
 Contagious ulcer         62
 Contraction of the oeso-
    phagus    -    -    153
 Contusions       -       73
 Contused wounds         29
 Couching,  operation of   120
 Cremor lith acet.     -     4
 Crural hernia      -      100
 Cupping       -    -     46
 Cutting the tongue      148

              D.

 Deafness of old people   1J9
  Deficiency of wax in the
    ear      -       -      137 
tN-DEX,
Diffused aneurism
Disease of the hip-joint
Diseases of the eye
-------of the ear
——— of the nose and
  its appendages
——— of the lips
-------of the interior of
Page
 88
175
111
135

140
144

147
 the mouth
------'■ of the alimentary
 canal       .     •     153
------of the respiratory
                       157
                       160
                       164
                       168
 organs
------of the chest
------of the breast
    -- of the joints
205
240
187
178

179
180
 ib.
-------of the urinary
  and genital organs
——— about the anus
-------of the bones
Dislocation
---------of the lower
  jaw
     ----of the head
 ■     ---of the spine
     ----of the clavicle 181
---------of the humerus
  downwards     -      1§2
---------of the humerus
  forwards     -     -     ib,
----------of the humerus
  backwards      -       ib.
     ----of the radius
                        183
                        184
                         ib.
 and ulna
_____---0f the wrist
--------of the hip
--------of the  hip
 downwards into the
ib.
 foramen ovale
----—— of the hip for-
 w.-.rds on the pubes
--------of the hip up-
 wards and backwards
 on the ileum
--------of the patella 186
--------of the tibia   187
--------of the ancle    ib.
185
185
                        Vage
Division of the parotid
  duct      -     -     151
Drr psy of the eye        130
Dysuria     -      ►      213
Ear, diseases of    -    135
----} inflammation of      ib.
----, suppuration of       ib.
----, deficiency of wax in 137
—-, polypus of    -    138
----, atony of the muscles
  or nerves of     -       ib.
----, extraneous bodies in 139
Effervescent cataplasm    12
Effusion      -     -      7
Embrocatio ammoniae      73
Emplastrum euphorbii     78
-----------ammoniaci
  cum cicuta      .      172
Empyema       -       160
Encysted tumors     -    77
Eneuresis     -    -     212
Enlargement of the ab-
  sorbent glands     -    82
-----------of the tonsils 152
----—-----of the uvula 153
—————— of the pros-
  tate gland       -      219
Eustachian tube,  closing
  of                    137
Excrescence of the eye   124
Exfoliation    -    -    189
Exomphalos      -      102
Exostosis     -     -     192
--------operation for   193
External piles     -      240
Extirpation of the breast  167
Extraction  of a stone in
  the urethra      .     211
Eye, diseases of    -     111
----, inflammation of      ib.
----,films of      .      123
----, abscess of    -     125
——, ulcer of     .      126
----, fungus of     -      ib. 
INDEX.
                        Page
Eye, steatpmatous tumors
  of    -               127
——, gaping       -      129
——, dropsy of    -     130
----, protrusion of        ib
—~—, cancer of    •.     131
—-—, extraction of        ib
Eyelids, concretion of    129
———, retortion of       ib.

             F.
False aneurism     -     88
Femoral hernia     -      90
Films of the oye    -     323
Fingers, amputation of   258
Fistula iachrvmalis       132
——— in perineo        218
-----in perineo, opera-
  tion for     -    -     218
——— in ano      -     243
-----in ano, operation
  for      -      -      244
Foroentum  cicutae          9
--------papav<M-is albi  ib.
--------ammoniae mu-
  riati cnmphoralae       59
foot, blood-letting from   42
Fore-arm, amputation  of 262
.-----—, blood-letting
  from      -       -    40
Fracture     -     -     133
.-------of the bones of
  the nose     -    -     194
.-------of the lower jaw ib.
.-------of the clavicle  195
-------of the ribs      196
----,---of the scapula   ib.
 -------of the humerus 197
—-----of the radius and
  ulna      -     -      1^3-
-------of the os.femoris ib.
-------of the patella  200
 -------of the olecranon 201
 ------- of the tibia and
  fibula     -     -     ib.
                        Page
Fracture of the fibula a-
  lone      -      -    202
-------compound.       ib.
Frontal and sphaenoidal
  sinuses, collections of
  matter in       -       144
Fungus cerebri     -     1j8
--------of the eye      126
Furunculus        -       69
Ganglion                 78
Gaping eye      -       129
Genital organs, diseases of 205
Gleet    '  -      -     224
Gonorrhoea       -      220
Gun-shot wounds         57
Gutta serena       -     117
H.
 63
14 4
145
239
Habitual ulcer
Hare-lip
------. operation for
Hematocele
Hemorrhage from  the
  nose     -      -     140
Haemorrhoids       -     240
iKtad. dislocation of      180
Hernia       -      -      90
-----, congenita     -    99
-----, femoral     -     90
-----cerebri     -     108
-----humoralis        235
Hip, dislocation of       184
Hip-joint  disease of     175
Hordeolum       -       127
Humerus, dislocation of 182
-------.fracture of     197
—:—r-—, amputation of 262
Hvdarthrus       -       168
Hydrocele      -       230
—------of the tunica
  vaginalis       -       ib-
----*----of the spermatic
  Cord      -      -     333 
INDEX.
                        Page
Hydrocele of the scrotum 233
Hydrothorax      -     162

              I.
Imperforate meatus audi-
  torius        -        139
-----------nostril      142
    '■'  ----anus        156
Incised wounds     -      13
Incontinence of urine    212
Inflammation        .       1
•-----, phlegmonous ib.
-----------, erysipelatous  4
-----------,  terminations
   of       -        -      7
 '      ----of the integu-
   ments from blood-letting 43
 —— —— of a vein from
   blood-letting     -      ib.
            . of the absorb-
   ents from blood-letting  44
 ----------of the subja-
   cent fascia  from blood-
   letting      -     -     ib.
 .__________of the brain  110
 —~—_----of the eye   111
 ----------of the ear   135
 ————- of the breast 164
 ■          of the bones 187
 Injuries of the brain from
   external violence      103
 ------to the brain, eon-
    sequences  of     -      108
 Insects, bite of      -     33
 Internal piles     -      240
 Intestines, ulceration of   155
 Introduction  of the sound  208
 Inversion of the cilia      128
 Ischuria     -      -     21"
 Issues       -       -     46

               J.
 Joints, diseases of        168
  -----, collections of blood
    ;-     .     .     -    169
           Page
K.
             L.

Lacerated wounds         29
Larynx, ulcer in    -    157
Leeches, application of    45
Leg, amputation of      261
Linimentum oleosum      66
Lip,cancer of    ' -     146
Lips, diseases of     -    144
Lithotomy in the male   208
—-------in the female   210
Local vitiated ulcer      50
----symptoms of syphilis 248
Lotio spirituosa     -      3
——myrrhae       -      59
  ■   ammonia: muriatae
   cum aceto       -      235
Lower jaw, dislocation of 179
.  .. —---, fracture of    194

              M.

 Mastodynia       -      164
 Meatus auditorius, imper-
  forated    -     -     139
 Mercurial ulcers  of the
    mouth      -     -     143
 Mollities ossium         193
 Mortification       -       10
 -----------of the bones 189
 Mouth, diseases of      147
 Muscles of the ear, atony
    of                    138

               N.

  Natron vitriolatv.m, cata-       .
    plasm of      -      115-3?
  Neck, blood-letting from   41  *
  Necrosis     -»     -     190
  Nerve,  wounded from
    bleeding    -     -     44-
  Nerves of the car, atony of 13H
Kidnev, stone in    *    205
Aa2 
INDEX,
Nose and appendages, dis-
  eases of     -     -    140
----, polypi of     -     141
——, fracture of the bones
  of      -      -      194
Nostril, imperforated     142


Olecranon, fracture of    201
Oleum palms camphora-
  tum     ---     9
Open piles    -    -    240
Operation for obliterating
  the saphsena vein        55
—-------for aneurism     86
———.— for popliteal a>
neurism
87
for strangulated
  femoral hernia     -     96
    ■—— of trepanning   106
------—• of couching    120
    ■   — of extraction   121
——•      of removing the
  eye     -    -     -    131
1  ■        for perforating
  the tympanum         138
 ■■       for perforating
  the meatus auditorious
  when closed      -    140
-----:--- for perforating
  the antrum of Highmore 143
----     for the hare-lip 145
-------- for  extracting
  fungous  substances
 from within the cap-
 sular ligament
-------for stone in the
bladder, in the male
       for stone in the
  bladder, in the female
«--------for extracting a
  stone in the urethra
—------for puncturing
  the bladder
173

208
no
211

216
Operation for  fistula in
  perineo
——----for phymosis
--------for paraphymo-
  sis
          for amputation
of the penis
       for hydrocele,
Page

218
228

229

230
  palliative and radical   232
——----for castration   238
--------for fistula in ano 243
Ophthalmia       -       111
--------— membranarum ib.
----------tarsi         112
Opiatum collyrium       115
Os femoris, fracture of   198
Ozaena       -     -     142

             P.

Papaveris albi fomentum    9
Paracentesis of the thorax 162
-----------of the abdo-
  men       -    -     163
Paraphymosis     -     228
------------, operation
  for      -      -      229
Paronychia     i     -    66
Parotid duct, division of  151
Pasta piperis composita  242
Patella dislocation of   186
------, fracture of      200
Pea-issue     -     -     47
Penis, amputation of    230
Perforating the meatus au-
   duorius, when closed   140
Pernio      -      -     70
Phagedenic ulcer         61
Phlegmonous inflammation  1
Phymosis     -    -      228
--------, operation for    ib.
Piles     -               240
Poisoned wounds    -    31
Polypi of the nose        141
 Polypus of the ear        138 
INDEJi
	Pap«
Popliteal aneurism	85
	
tion for	87
Primary symptoms of sy-	
philis	248
Progress of spontaneous	
union	13
Prolapsus ani	245
Prostate gland, enlarge-	
ment of	219
Protrusion of the eye	130
Psoas abscess	177
Pterygium	124
Pulvis rhabarbari compo-	
situs	75
■ sabinae Composi-	
tus	ib
Punctured wounds	29
Puncturing the bladder in	
the perineum	216
----------the bladder	
through the rectum	ib.
-------■— the bladder	
above the pubis	ib.
Pylorus, scirrhus of	155
R.
Rabid animals, bites of     31
Rachitis       -     -     193
Radical cure for hydrocele 232
Radius and ulna, disloca-
  tion of        -        183
------and ulna, fracture
  of    -                198
Ranula       -     -      149
Rattlesnake, bite of       32
Rectum, scirrhous con-
  tractions of      -      156
Resolution        -        7
Respiratory organs, dis-
  eases of    -     -     157
Retention of urine        213
Retortion of the  eyelids   129
R.bs, fracture of         196
Rupture of the urethra    217
                        -Jagie
             S.

Saphaena vein, obliteration
  of                      5S
Sarcomatous tumor of the
  lip       -       -       147
———-----tumors        74
Scalds                    64
Scapula, fracture of       196
Scarification        -      46
Scirrhus      -     -      8
--------of the pylorus   155
--------of the testicle   237
Scorbutic ulcer       56, 150
Scrofulous ulcer           58
Serpents, bite of    -     34
Seton       -      -      48
Shoulder-joint, amputation
   of       -       -       262
Sibbennic ulcers          147
Solutio  argenti nitrati      5l
Sound,  introduction of    208
Spasmodic stricture       214
Specks  of the eye         123
Spine, dislocation of      180
----, caries of    -      191
Spontaneous  union, prog-
   ress of     -     -     13
Steatomous tumors        76
----------tumors of the
   eye      -      -     127
Stone in the kidney"       205
---- in the ureter         ib.
---- in the bladder        ib,
-  i   in the bladder, ope-
   ration for,  in the male  208
—— in the bladder, ope-
   ration for, in the female 210
---- in the urethra      ' 211
----  in the urethra, ope-
   ration for       -        ib.
Strangulated femoral her-
   nia      -      -       94
----------femoral  her-
   nia, operation for        96
Strangury        -       213 
INDEX.
                        Page
Stricture        •        226
-------spasmodic      214
Stye    ...    127
Suppuration      -        8
---------■ of the ear    135
Suspended animation     158
Syphilis       -    -     248
------, primary symp-
  toms of        -        ib.
------, secondary       251
Syphilitic sore throat      ib.
-------eruption        253
------- ulcers    -     234
——— ozcena    -     255
-------ophthalmia     256
-------pains     -      ib
■-------node     -     257

             T.

Tarsus, amputation of   259
Temporal artery, blood-
  letting from      -     42
Tenaculum, use of      '15
Terminations of inflam-
  mation      -      -     7
Thigh, amputation of    260
Thorax, paracentesis of  162
Tibia, dislocation of     187
Tibia and fibula, fracture
  of      -      -      201
Tongue-tied       -      148
———----, cutting of    ib.
Tongue, cancer of       150
Tonsils, enlargement of  152
Topical bleeding         45
Tournequet, application of 15
Trepanning      -      106
Trichiasis       -       128
Truss, application of     93
Tumors, sarcomatous     74
=-----, steatomatous     76
*—;----, steatomatous. of
  the ey©               127
Ulcer, benign      -      49
------, local vitiated       50
-----, phagedenic        61
-----of the eye    -    126
-----in the larynx       157
Ulceration  of the intes-
  tines         -         155
Ulcers                   48
------,  vitiated constitu-
  tional      -      -     57
———,  sibbenic    -    147
-----,  scorbutic         150
Ulna and radius, disloca-
  tion of     -     -     183
----and radius, fracture
  of      -      -      198
Unguentum cicutae       117
---------ophthalmi-
  cum      -     -     124
--------- gallae  cam-
  phoratum      -      242
Uninterrupted suture      23
Ureter, stone in    -     205
Urethra, stone in         211
------, stone in, opera-
  tion for     -     -     ib.
------, rupture of      217
Urinary organs, diseases
  of      -      -      205
Urine, incontinence of   212
Uvula, enlargement of   153

             V.

Varicocele       -       234
Varicose aneurism        89
Venereal ulcer     -     254
Viper, bite of       -      32

             \V.

Ward's paste      -     24? 
lNDE^C.
                        Page
Warts of the eye         1^7
Wax,  t ccumulation of,
  in the ear       -       136
----. deficiency of, in the
  ear       -      -      137
White swelling    -     170
Wbitl "v           -      66
Wounded  nerve,  from
  blood-letting      -      44
Wounds       -     -     13
------, incised     -     ib
------of the chest       18
------of the abdomen,
   superficial      -      20
 ------of the stomich    21
------of the intestines   22
------of the gull bladder 24
  ....   ... of the liver       ib.
Wounds of the spleen
------of the kidney
       of the recepta-
 culum chyli
-----of the
urinary
  bladder
------of joints
------of the neck
------of the tendons
------, contused
------, lacerated
------, poisoned
------, punctured
------, gun-shot
------of the eyelid
------of the eyeball
Wrist, dislocation  of
—— -, amputation at
Page
 25
 ib.

 ib.

 ib.
 26
 27
 28
 29
 ib.
 31
  29
  37
 122
 ib.
 184
 259
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