Dissertations on Inflammation, Vol. 2

by John Burns

Sea salt, mixed with bile, has been recommended, but has very little effect.

Camphorated liniment is very frequently used, in which case the part is generally kept warm with flannel. It does not, however, appear to possess any very great power of discussing these tumors; but the friction which is made use of with these sometimes hastens the removal of these tumors, and may be usefully alternated with the use of the saturnine lotion. A mixture of ether and linimentum opiatum may be employed for the same purpose.

Hemlock poultices were at one time in repute, but they have now lost their character.

By these means, even after a small quantity of matter is formed in the gland or tumor, we may discuss the tumor, or make it less; but, if the quantity of matter should continue to augment, we may consider resolution as out of the question. Our object must then be to bring the part to suppuration as quickly as possible; because we not only thus shorten a process which must be completed before the parts can be healed, but also render the ulcerative action more healthy, and easier induced; for the more quickly that the suppurative action is performed, the sooner does the ulcerative action take place, and the more vigorous is it, provided that no new cause render it unhealthy, as has formerly been mentioned.

This advice, however, must not be adopted without some exceptions, and must be chiefly confined to affections of the glands and cellular substance, and ought not to be extended to the joints. In these cases, even although a small quantity of matter form, we ought still to endeavour to prevent general suppuration, and the bursting of an abscess; because this would, instead of accelerating the cure, as is frequently the effect in the other case, be attended with dangerous consequences; we must therefore rather continue the use of the issues, and endeavour to procure the absorption of what matter is already formed.

The means employed for promoting suppuration were formerly poultices of lily roots, honey, &c. alternated with fomentations prepared from pomegranate seeds, and myrrh, and cypress leaves, or, occasionally, stimulating plasters; but now the common bread and milk poultice is advantageously substituted in place of these remedies. When the process is very tedious, electricity is useful along with the poultices.

When these tumors have suppurated freely, and an abscess occupies the whole of the gland, it is useful to evacuate the matter by a small opening with a lancet, if there be no appearance of the abscess bursting quickly, and the sooner this is done the better. When this is done, a poultice should be applied until next day, the part is then to be wiped clean and dry, and a small bit of lint, spread with simple ointment, applied on the orifice. The surrounding red skin is to be dulled with powdered cerussa[100], and then covered with dry lint. A compress is to be laid over the whole, and moderate pressure employed. These applications are to be renewed every day, or twice a-day, according to the quantity of the discharge, and other circumstances; and, at each dressing, the parts may be bathed with spirit of wine. If this mode of dressing does not produce a cure, but the opening enlarges, and the surface ulcerates, we must then employ the dressings for a scrophulous sore.

When, notwithstanding the use of issues, matter is formed in joints, or, when these fail to procure the absorption of what was formed before they were introduced, then one of two things must happen; either the abscess must be punctured, or it must be allowed to burst of its own accord. In general, I believe, it is most advantageous to allow the abscess to burst, without any interference, except the continuance of the issue, or the establishment of such new ones as circumstances, particularly the situation of the pain, may point out. If, however, it were at any time deemed proper to evacuate the matter, this ought to be done with a small trocar, at different times, in the manner recommended by Mr. Abernethy for the cure of lumber abscess. This is infinitely preferable to the barbarous practice which even some surgeons high in reputation advise and make use of, I mean the insertion of a seton through the abscess of the joint[101].