41. Abscessus spirituosus. See Aneuris-ma.
42. Abscessus splenis. An abscess of the Spleen. This viscus is rarely the seat of abscess; but when it is, and the suppuration is completed, for the most part it is easily perceived by the pressure of a finger; when this tumour is ready to break, the nausea and anxiety are very great. Sometimes, indeed, an abscess is formed on this part, and escapes all observation, on account of its exciting no uneasy symptoms. Lommius says, in his Medical Observations, that "an abscess in the spleen is attended with nearly the same signs as the same complaint in the liver:"and Aretaeus observes, that a drop-sical kind of swelling attends the patient, his skin is of a blackish and greenish colour, he is restless, breathes with difficulty, his belly is tumid with vapours, and there is a sort of cough, by which little is discharged."
When this kind of abscess bursts, there is no pure digested pus, but an ash-coloured, or a brown or livid matter; and if it is deep, a blackish sort of humour, with some of the juice of the tabid spleen, is evacuated. If the feces are watery, and become more so, the disor der ends well; but if the ulcer continues long, a loss of appetite comes on with a general bad habit of body, livid coloured and foul ulcers break out, particularly on the legs, and, in short, a stop is put to affliction only by death's approach. Endeavours to prevent suppuration should not be neglected as soon as the complaint is perceived; if those fail, cataplasms of the briony root are preferred, as the most effectual digestive. See Oribas. De Morb. Curat. lib. iii. cap. 43. Paulus Aegineta, lib. iv. cap. 18. Asiatic Researches, vol. vii. for the Indian method of cure.
43. Abscessus temporalis musculi. An abscess of the temporal Muscle. The violent pain occasioned by an inflammation and suppuration in this part is from the confinement of the matter under the tendinous sheath which covers it. If not evacuated, it passes under the zygomatic process on the outside of the dentes molares, and from a tumour there it may be discharged. Dr. Hunter observes that.when the pain hath been violent, and the fever thus excited considerable, he hath with advantage made an incision along the muscles; and he advises, when an inflammation is considerable, that we open the part without delay, for we never can perceive any fluctuation there, as the fascia is so tight. See Kirkland's Medical Surgery, ii. 133.
44. Abscessus testium. Abscess of the Testicles. See Hernia humoralis.
45. Abscessus tonsillarum. An abscess of the Tonsils. Abscesses in this part endanger suffocation. If bleeding, purging, or blistering behind the ears do not succeed, and a suppuration should take place, incisions may be made with a lancet into the body of the tumour. Thus, by discharging some of the blood and humours before they are formed into pus, the dangerous degree of swelling is prevented. It is never prudent to leave the matter till it is formed into perfect pus; but, at the latest, the puncture should be made as soon as the appearance of digested matter can be perceived. It happens sometimes, that when the patient is on the point of suffocation, a sudden spontaneous discharge gives instant relief; as soon as the tonsils have emptied themselves, they contract, and by the assistance of a gargle, made with the decoct. cort. Peruviani et mel rosae, a cure is completed in a few days.
46. Abscessus uteri. An abscess in the Womb. When the inflammation begins to suppurate, bladders of warm water should be applied over the part; and sitting frequently over the steams of warm water should be advised. Oribasius observes, that these abscesses sometimes discharge themselves into the cavity of the uterus, at others into the intestinum rectum, or into the bladder. Forestus says, that if the discharge is into the cavity of the womb, and is whitish, the patient may recover; but if the abscess continues long, the discharge becomes greenish or dark-coloured, and offensive with lancinating pains, the greatest danger is to be apprehended.
47. Abscessus vesicae urinariae. An abscess in the Urinary Bladder. An inflammation in the bladder is sometimes followed by an abscess. When this happens, it is known by an exacerbation of the symptoms, and a sense of weight in the parts about the perinaeum and pubes. Emollient fluids, mixed with warm milk, may be injected into the bladder very frequently, to hasten the suppuration, and to solicit the discharge into its cavity. Besides injections, warm emollient clysters, with powdered opium in substance, should be given and often repeated; with gentle laxatives either of castor oil or soap interposed. Warm poultices may be applied to the perinaeum or pubes, according to the seat of the pain. When the pus is formed, the bladder may be frequently washed according to the plan recommended by Jesse Foot. If the pus is not soon evacuated, it acquires an acrimony, and corrodes the adjacent parts, produces fistulas, and other inconveniences. If the injections fail, there is no resource but that of an operation; and, though rarely required, two examples of it are recorded in Boneti Sepulch. lib. iii.
An ulcer of the bladder or of the kidneys is, however, an uncommon complaint. We sometimes find an apparently purulent deposition in the urine, which consists of a light mucus only, from a disease to be afterwards noticed, Catarrhus Vesicae. Previous painful affections of the bladder, with fever, and an offensive smell, chiefly point out the existence of the abscess. Without these, the disease is probably only a catarrh. In a long and extensive practice, we have seen only two cases of inflammation of the bladder from an internal cause, neither of which had the slightest tendency to suppuration.
Authors to be consulted on abscesses are Hippocrates, Aretaeus, Celsus, Paulus .Aegineta, Oribasius, Aetius, Actuarius, Hildanus, etc.; and among those of later date, Boerhaave, Wiseman, Turner, Heister, Sharpe, Dease, and Bell.