32. Abscessus pedum. Abscesses in the Feet. Of all the sorts that affect these parts, the strumous, which are most common, are the worst, for in these instances the bones are usually affected; but abscesses of every kind are bad, as they are apt to form sinuous ulcers, and produce caries in the bones. The applications and general management are here as in other cases.

33. Abscessus pericardii. An abscess of the Pericardium. Little has been said by authors concerning this subject, any further than dissections have proved that such a disease exists, and that it has sometimes come on independent of any symptoms indicative of pneumonic affections, with which the state preceding suppuration is often joined. If these have preceded, the usual methods of checking inflammation must be attempted.

34. Abscessus perinae'i. An abscess in the Perineum. Anabscess, if suspected to be forming in this part, should be prevented, because of its troublesome effects; it retards, or totally prevents, the discharge of urine. In other circumstances it may penetrate into the bladder, or rectum, and produce a troublesome or incurable fistulous opening. It may happen from any cause, but the most common origin is a venereal affection; and we have seen it from a misplaced gouty inflammation. It requires no peculiar treatment, except particular care to keep the abscess clean; and as the part is seldom susceptible of very active inflammation, the applications should be warm and antiseptic. The original cause will require minute attention according to its nature. See a singular case in Le Dran's Observations. See Kirkland's Med. Surgery, ii. 253. and Pott's Works.

35. Abscessus periostei. An abscess of the Periosteum. This case is known by evident inflammation, swelling,and pulsation in the part, and irregular shiver-ings. As the suppuration approaches and proceeds, all the symptoms are augmented; but the principal sign is the irregular horripilation. Sometimes the diagnostics are obscure, because the quantity of matter collected, though productive of violent symptoms, is too small to raise a sensible tumour, and in such cases the pain does not remit, though the pus is formed; besides, the matter gradually increasing in quantity, unless it corrodes the periosteum, passes between it and the subjacent bone, and thus, by gradually separating them, keeps up a most violent pain. An accident of this kind soon lays the bone bare, and corrupts by destroying the vessels which nourish it. If the pus corrodes the periosteum, and spreads through the softer parts, it produces fistulous ulcers. When this disorder is manifest, a speedy discharge is to be aimed at, and the bone must be treated in the same manner as the skull when denuded, first make an incision through the teguments only; for when the periosteum is corroded, the matter generally soon makes a way betwixt the muscles, in which case it is a guide to the operator in piercing to the bone, which, when laid bare, the remaining procedure will be as in deep abscesses, and when the skull is deprived of its pericranium.

36. Abscessus pleurae. An abscess of the Pleura. When this is suspected, an opening must be made into it as early as possible, lest it burst into the cavity of the breast, and form an empyema. As it seldom happens, however, that the pleura is affected, without some previous inflammation of the lungs, and as the lungs more readily suppurate than the denser membrane, we scarcely, in any instance, find this abscess unmixed. When it does occur, and shows its real seat, by a slight external tumour, it may be-opened with a small trocar, or more safely by a caustic, fixing the caustic rather below the part where the tumour is most full. In this way, if the strength be supported, we have more than once preserved the patient's life, though the lungs were affected. When the case is more clear, as where it happens from an accident, and the pleura is alone affected, a blister (rendered perpetual) or a seton, will only be necessary; and these will effectually prevent its opening into the cavity of the breast. See many satisfactory remarks on this subject in Sharpe's Critical Enquiry, and in Le Dran's Observations and Operations.

37. Abscessus pudendae. An abscess of the Pudenda. See Alae.

38. Abscessus pulmonum. An abscess of the Lungs. See above Abscessus Pleurae, et Vomica.

39. Abscessus renis. An abscess in the Kidney. When an inflammation in the kidney suppurates, it is known by the following signs; viz. a remission of the pain, which is succeeded by a pulsation, a frequently returning horror, a weight and stupor in the part, with a heat and tension; the urine is purulent and fetid some-times, and, at others, a whitish pus is discharged with it, in which is nothing offensive. If this suppuration continues some time, the whole kidney being consumed, it forms a kind of bag of no use; and in this case, a tabes renalis is frequently present; but if a small quantity of the inflammatory matter remains coagulated in the minute folliculae of the urine, it forms a basis to which the sabulous matter, which continually is passing by it, will adhere, and gradually form a stone, and which, also, by the same means will be augmented. When the abscess is burst, the urine becomes purulent: and though in these cases the discharge ceases, the kidney shrinks into a withered state, and all complaints are ended at some certain period; yet, to hasten this relief, diluting and gently diuretic liquors may be used, gentle laxatives and balsamics also, and probably the bark may much conduce to expediting a cure. An abscess of the kidney is, however, more frequently of a chronic nature, without previous observable inflammation, as the part is not acutely "sensible, and the seat of pain in deep parts not to be referred with accuracy to one spot. Stone in the kidneys, from a nucleus of pus, is in these cases very uncommon, and indeed rare in every other.

40. Abscessus sinus maxillaris. An abscess in the Maxillary Sinus, called the Antrum Highmorianum. Drake mentions this as a species ofozaena. It is known by a pain which is deep seated in the nose, eyes, and cheek, and a tumour on the outer and upperpart of the latter; a discharge of offensive matter from the nostril of the affected side, especially on inclining the head to the side that is sound; sometimes the breath is rendered very disagreeable by the caries produced in the teeth by this disorder. Mr. John Hunter observes, in his Natural History of the Human Teeth, part ii. that, "The pain in this disease is at first taken for the tooth-ache; however, in these cases, the nose is more affected than is observed in a tooth-ache. The eye is also affected; and it is very common for people with such a disease to have a severe pain in the forehead, where the frontal sinuses are placed; but still these symptoms are not sufficient to distinguish the disease. Time must disclose the true cause of the pain, for it will commonly continue longer than that which arises from a diseased tooth, and will become more and more severe; after which, a redness will be observed on the fore part of the cheek, somewhat higher than the roots of the teeth, and a hardness in the same place, which will be considerably circumscribed; this hardness may be felt rather highly situated on the inside of the lip."the method of cure by drawing one of the dentes molares from the affected side was first proposed and practised by Drake, and his improvement hath been continued with the happiest success. Draw the last tooth but one; and, if rotten, draw the next on each side of it, then through their sockets make a perforation into the antrum with a large awl; the matter being discharged, the cure may be finished by injecting a mixture of aq. calcis, tinct. myrrh, and mel rosae, twice a day into the cavity, and retaining it with a tent. See Gooch's Cases and Remarks, in which an extraordinary instance is related, with the subsequent ingenious and successful management. Mr."john Hunter proposes to effect the cure as follows: 1st, if the disease is known before the destruction of the fore part of the bone, make an opening through the partition between the antrum and the nose; or, 2dly, by drawing a tooth, as above: the latter method he prefers. Bell's Surgery, iv. 209. Kirkland's Med. Surgery, ii. 150.