Abscesses from their seat and their consequences are often highly dangerous; and it is of the greatest importance to prevent or discuss them. The abscess, for instance, in the psoas muscle, is generally fatal. We can, however, seldom succeed in the attempt to discuss them. The psoas abscess has, indeed, in the opinion of many practitioners, been prevented by active bleeding; yet, in the early stages, it is with great difficulty discriminated; and to use so violent a remedy for even-slight strain would be-highly improper. Active emetics have also contributed to dissipate the congested fluids of inflamed parts, and these have at times removed the inflammation of the testicle; but neither remedy can be employed with the necessary violence in internal inflammations. If we bleed too copiously in pneumonia, we check the expectoration, and the patient dies: if we give emetics in hepatitis, we aggravate inflammation, or burst an abscess, if any has formed.

When suppuration is to be promoted, endeavour,

1st. To convert into pus the congested fluids.

2dly. To assist the discharge of the matter when it is duly digested.

3dly. To heal up the opening, or ulcer; for thus the abscess is denominated when the matter is discharged.

In order to the accomplishment of the first intention. in strong habits, avoid every stimulant, apply warm and moist applications, which will long retain their heat and not grow hard. The bread and milk poultice, occasionally with the roots of the white lily, united with a little oil, or the meal of lintseed made into a poultice, which contains already an oily matter, are only necessary. Even leeches, which lessen inflammation, will occasionally relieve the vessels, and increase the salutary effusion. If the abscess is deep, or the suppuration does not rapidly increase, a little of the digestive ointment may be added to the poultice, a stimulating fomentation may be employed, or a gum plaster laid on the part.

While externals are applied, the state of the constitution is not to be neglected; too much heat endangers a mortification, and with too little every attempt will be abortive. If the heat runs high, reduce it nearly to a state of health by bleeding and a cooling regimen. If costiveness incommodes, gentle laxatives or a clyster may be used. If a defective heat retards the suppuration, warming medicines, and a cordial diet, are required.

For a due fulfilling the second intention, the whole of the tumour, or nearly so, must be converted into pus, before a discharge can be admitted; otherwise all that remains unsuppurated will digest slowly and with difficulty. To this, however, there are some exceptions: - the abscesses which are critical in malignant fevers must be opened soon: nature cannot finish the operation; she must be relieved, and the discharge afterwards regulated or corrected. Again, if a due discharge is not obtained as soon as the pus is perfected, it putrifies, and forms an unfavourable opening; or it will be absorbed, and cause a fatal hectic fever. The time of opening is generally to be known by the prominence observed being very thin, the matter fluctuating on the lightest pressure, and an abatement of the pain, heat, and pulsation in the part.

Abscesses are opened either with a knife, lancet, or the caustic; but in general the first is to be preferred, for it is less painful than the caustic. The opening may be as far as the skin is discoloured; or a circular piece may be taken out if the discoloration spreads. The opening must be. if possible, in a depending part; or as near to it as nature points. When the bad quality of an abscess is likely to retard its future incarnation, an opening made by a caustic best prevents the lips of the wound from growing callous. Venereal buboes, and some indolent or scrofulous tumours, if not in the face or neck, are soonest healed after opening with a caustic; and such of these as neither will give way to suppurating nor discutient medicines are effectually destrayed by caustics, and the eschar soon is cicatrised. See the article Escharotica..

Many advise not to open critical abscesses before they are digested. Sharpe says, that "very little of the morbid matter is deposited in them before they are fully ripe, therefore till then they should not be opened."

It is certain that, by a premature discharge, the ulcer becomes foul, and heals with difficulty. .

When the knife is used, if a nerve, vein, or artery, is in danger, let a director guide the incision, which is best begun on the lower side, for then the matter is discharged most freely, and the operator least incommod-. ed by it. If possible, its course should be according to that of the fibres of the subjacent parts: thus, if the skin is very near a nerve, the use of the part will not be injured by cutting it across.

In some cases, particularly-in abscesses of the breast, the abdomen, and in very large abscesses of other parts, where the discharge of the matter at once would be injurious from the debility it would occasion, or where the admission of air would be dangerous, a seton is passed, from above, below; (see Seton). The matter is then discharged slowly, the access of air prevented, and the irritation occasioned by the motion of the cotton contributes to the diminution of the sac, in consequence of the inflammation excited, which produces adhesion. The length of the upper part of the cotton should be considerable, that it may be drawn down, and the purulent part be occasionally cut off: When the matter of a psoas- abscess passing along the fibres of the muscles appears at the surface near the groin, or, penetrating through them, at the back, the matter has been evacuated slowly by using a small trocar, which admits but of a little, if any, air. When the wound closes, the perforation is repeated. We have not, however, found this plan very efficacious.

As to the third intention, it may be observed, in general, that, when the opening and discharge are made, the case is considered as a common wound, and the treatment is as directed in the article Vulnus. The first dressing may be dry lint, covered with pledgets of soft tow. Afterwards, if the part is tender, and the matter good, when the applications are removed, be content without wiping it very clean, as it is thus irritated. Pledgets that are spread with ointments need not be warmed, except the patient complains of their coldness, and then hold them to the fire, but not so long as that their surfaces melt. Observe a proper posture, which will favour the discharge. Repeat the dressings once or twice a day, as the quantity or the quality of the discharge requires; the seldomer they need a repetition, the sooner will the cure be perfected; and as the air offends not, except by long exposure to it, all hurry is unnecessary. Bell on Ulcers, edit. iii. p. 54. 93. Kirkland's Medical Surgery, vol. ii. 19. 62.