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nish has a contagious property. I know A boil is, therefore, an inflammatory a person who has on his hand a chain of swelling of the cellular substance and the warts, which he says are dereloped exactly skin-is circumscribed, conical, and proon the line of a streak of blood shed in minent; bard, very red, hot, and painful, cutting another wart. They occur at all and terminates in the formation of a very ages, but they are certainly most fre. small quantity of matter, and the expul. quently seen in childhood and youth ; and sion of a mass of mortified cellular tissue, especially in those who handle irritating The buttocks, the thighs, the back, the substances, or have little regard to cleanli. axilla, the neck, and the parietes of the ness. Some persons appear to have a abdomen, are the regions of the body for kind of predisposition to them, and they which they seem to manifest a preference. return after they have been destroyed, in Usually a boil is not seen alone ; it has spite of every regard to cleanliness. Warts others near it. Strictly speaking the inoften disappear spontaneously-are easily flammation of a single cone constitutes a removed or destroyed ; but in either case boil; but at certain seasons, and in many are apt to be re-produced. They may be cases as a consequence of bad or insuffi. tied with a silk thread or horse hair; if cient food, a larger tumor is developed, their base be broad, they may be removed but without the constitutional symptiims with a knife or curved scissors, or may be of anthrax. Last year I had, at ihe same
I destroyed by caustic. When they are ex- time, two patients; one, a woman of 22, cised, they onght first to be bathed for living in London ; the other, an Irish half an hour in warm soapy water; they woman, a bay-maker, aged 40, with this must then be removed by thin layers until species of tumor in the suprá clavicular they begin to bleed, when the surface fossa. These tumors have been named by shonld be rubbed orer with lunar caustic. some pathologists furunculus anthracoïdes. When nitric acid is employed, the sur- A boil begins by a small hard conical rounding parts must be protected by adhe- tumor, of a brigli or violet red colour, sive plaister. A strong solution of the which, in a few days, principally by irrimuriate of ammonia applied upon them tating the surrounding tissue, may acquire twice a day will usually get rid of them. the size of a large nut, or walnut. The Certain acrid vegetable juices will also pain is sometimes very acute; compared, effect the object. The credulous believe by some, to the pain which would be pro. that they can be "charmed” away. The duced by a drill or giinblet. From the charmers may be divided into classes: one fourth to the eighth day it rises to a point; uses mystical words, and cure without the apex becomes white, softens, and 'touching them; those are inoffensive : finally gives way, when a sinall quantity another employ the juice of certain acrid of sanguinolent pus escapes by an opening herbs; this class may do mischief. The as small as if it had been made with a fine pretended cures depend, not upon the probe, and the subjacent slough is exmeans used, but upon the time they are posed; when this is expelled the tumor used. Warts tend to cure spontaneously seems to be pierced by an open-mouthed towards the age of puberty.
cylindrical cavity. The pain now ceases, the skin collapses, the cavity fills up, and,
by the end of a fortnight, no other trace is Furun, ulous inflammation, though it on. left than a small depressed cicatrix of a questionably affects the skin to a certain dusky red colour. extent, yet may inore properly be classed Furunculi are nerer dangerous of them. with the diseases of the cellular tissue. selves; but their situation sometimes ren.
The cells of the chorion are penetrated at ders them very troublesome. I recollect a all points by small conical prolongations, case in which one was developed in the derived from the subcutaneous cellular perineum between the anus and scrotum, membrane : inflammation of these pro- which rendered the excretion of urine very longations gives rise to furunculus or boil; difficult, and simulated a urinary abscess. the simultaneous and confluent inflamina- Treatment.--It is stated, in books, that tion of several of these appendices consti. we may prevent the development of a boil tutes anthrar. When these cones are so by applying a leech directly upon the little affected, the cutis resists their development, tumor, or by applying caustic potash, or and a species of strangulation and morti. lunar caustic, upon it. I have never suc. fication takes place. Left to themselves, ceeded with either of these means.
Warm these affections always terminate in the fomentations will usually afford relief; if, mortification and expulsion of one or more however, the pain be severe, the simple of these small cones. Furuncular inflam. division of ibe integtiment affords the most ination is commonly connected with a efficacious relief. As a topical application disordered condition of the stomach and a simple poultice is probably the best. howels, and is scarcely ever the effect of But in these cases, the cause being usually mere inflammations of ihe skin.
internal, and continuing to act, successive
DISEASES OF THE CELLULAR TISSCE.
ANTHRAX OR CARBUNCLE.
erope appear, and emetic or purgative me. that anthrax is connected with certain dicines are exhibited to arrest them. deranged functions of the stomach, the Fosbroke advised that diluted sulphuric liver, and the uterus ; and this appears acid should be largely administered as a reasonable when we consider how often very efectual means of lessening pain and anthrax seems to be caused by improper preventing successive eruption : I have food, how often it is presented in the chanever derived much advantage from this racter of a critical affection in persons treatment: but I constantly experience suffering from bilious or niucous fevers, the most signal good effects from the ex. and how commonly it is observed in women hibition of the liquor potassæ in infusion at the period when the menstrual function of gentian-half dram doses three times a ceases, as compared with any other epoch day.
Symptoms.— The occurrence of anthrax
is often preceded by boils; indeed, during Between furunculus and anthrax, the its development, we often see the point only anatomical distinction which can be surrounded by boils. Sometimes it apdrawn is, that the former affection is con- pears without any material constitutional fined to one, two, or three cellular cones; disturbance : at other times it is preceded the latter to many. Anthrax is usually by anorexia, lassitude, rigors, and other seen alone : furunculi are often numerous. symptoms which denote digestive derangeFurunculus is seen at all ages. Anthrax
At first there is little projection is rarely seen in children-is much more beyond the surface; and commonly its frequent in the adult, and in those broken extent is not great.
Sometimes during down by age, misery, intirmities, or by the first few days a flat vesicle is seen, filled good living.
with a reddish sanious fluid, as in maligThe term anthrax bas been applied to nant pustule. Usually its progress is two very different diseases; the one, pos. rapid ; and in eight or ten days it may sessing many characters in common with attain a surface equal in extent to the furunculus, differing from it only in palin of the hand : indeed, on the back, volume; the other, malignant in its nature, the thorax, and the abdomen, they have belongs to that class of gangrenous dis sometimes been seen nine or ten inches eases produced by miasma, or septic virus. in diameter. As the tumor enlarges, it
Furunculous Anthrar, which alone we projects so as occasionally to pass the level shall consider here, is an inflammatory of the skin by several inches. Anthrax tumor, circumscribed, very hard, very continues very hard up to the moment painful, of a dark red colour, and accom. when mortification seizes upon that part panied by burning heat. This tumor is of the cellular tissue wbich occupies the constantly terminated by the mortification most projecting part; and even when that of the cellular tissue which it affects, and portion is softened the surrounding part by the destruction of a portion of the skin continues hard, and the base enlarges. by which it is covered. Women and chil. The skin covering the tumor is of a violet dren are much more rarely the subjects of red colour, which does not disappear upon this disease than adults and old men. pressure; and around its base the redness
It is commonly developed in those situa. is erysipelatous: this indicates the ulterior tions where there is an abundance of cellu. progress of the disease. The heat is acrid lar tissue—the nape of the neck, between and burning, especially at the summit of the shoulders, the lumbar region, the the tumor; and it does not diminish until parietes of the thorax, the abdomen, and an opening is made. The pain is very the thighs. It is occasionally seen in the acute, but varies at different points of the inferior maxillary region, and in the supra. tumor ; sometimes it is heavy, dull, tenclavicular spaccs.
sive; at others, lancinating, and the paCauses. We are not at present cognizant tients complain of the lancinations extend. of the causes of this disease: in some ing to a considerable distance ; sometimes cases it would seem to be a consequence of it is a gnawing sensation, as if it were bad or indigestible food; in others, of the torn with teeth. Whenever the tumor is application of acrid or irritating substances large, or affects irritable subjects, there is to the skin, of punctures, or habitual filth; fever, restlessness, sleeplessness, the skin is but then it also attacks persons who are hot, the urine dark and in small quantity, the most attentive to cleanliness. It is and the head painful. certainly more frequently seen in spring Other symptoms may exist connected and autumn than in summer and winter: with the situation or size of the tumor. this would seem lo prove that damp, cold, Thus when it occupies the lateral or an. and vicissitudes of temperature, are favour- terior part of the neck, respiration and deable for its production. It not unfre- glutition may be impeded, a sensation of quently succeeds to measles and small-pox ħeat is complained of in the larynx and in adults. It is very generally believed trachea, and there may be a tronblesome
cough ; the face is puffy, and the head aged persons, or in those broken down by painful, from the jugular vein being inter other diseases, it may also be falal. fered with. If the tumor be seated on Ordinarily, however, when not very large, the thoracic parietes, respiration is em- and occurring in persons of good constitubarrassed, and the inflamination may be tion, the disease is not dangerous. extended to the pleura. If it be seated in Dupuytren was accustomed to divide the the abdominal parietes, still it affects res. progress of anthrax into four periods—that piration, and the pain is much increased of invasion, of suppuration, of “ detersion," by efforts in going to stool ; or, indeed, and of cicatrization. The first, characterised there may be vomiting, and even peritonitis. by loss of appetite, thirst, whitish or Left to itself, it softens at the summit, the yellowish coating on the tongue, with or skin is dark violet or bluish, and if the without redness of the edges ; sometimes finger be applied upon the point we be. epigastric tenderness, heat of skin, accelecome sensible of an obscure fluctuation. ration of pulse, and other signs of gastric After some days the skin ulcerates from irritation. In some cases the tumor apwithin outwards, and a small quantity of pears without these precursory symptoms. sanguinolent rus, together with some It is circumscribed, tense, red, livid, or shreds of sloughy cellular tissue, escapes; glistening, accompanied by burning beat. the opening enlarges, and a small quantity The inflammation proceeds for eight or of thick pus continues to flow out. Even ten days, and, when it has acquired a cer. after this you will often observe that the tain degree of intensity, reacts on internal anthrax continues to increase in extent and organs, whence results exasperation of the depth ; and then the relief which the pa. gastric symptoms, or their manifestation, tient experiences from the opening is if they are not already developed. The small. The softening goes on, and many second period extends from the tenth to irregular openings are formed; they en about the twentieth day. In this the suplarge and unite. Destruction is not limited purative action is established, and the to the skin and cellular tissue ; small cellular and fibrous lissues are inflamed arteries and veins are ulcerated, and blood and gavgrenous. The integument is perin small quantity often escapes; but I know forated from within ontwards by many no case where any considerable hæmor- very small openings, each corresponding rhage has occurred. When the skin is to the apex of a cellular cone; through largely perforated, we see distinctly the these small openings a purulent fluid sloughing cellular tissue. It exbales a
escapes. Soon these openings enlarge by fetid smell, not, however, like that yielded coalescing, and ultimately they are conby substances in a state of putrefaction; founded in one-in a single opening. We nor does it assume that dark colour which then see the slongh, resulting from the is seen in other kinds of gangrene. By mortification of the cellular tissue, impreglittle and little the cellular sloughs are nated with pus, and yielding a fetid odour. thrown off, suppuration becomes more Towards the end of this period, the pain, abundant, and the pus is thinner ; pain, the general heat, the quickened pulse, and heat, fever, and tension diminish. When the thirst diminish. The third period the sloughs are thrown off, the naked extends from the third to the fourth week; aponeurosis is often seen; it is perforated, the suppuration becomes more and more and the pus is seen to escape by the open: abundant, the slough is detached, and a ings wbich it presents. The skin corre- large wound is presented. The skin formsponding to the circumference of the tumor ing the edges of the ulcer is livid, bluish, is raised, thin, bluish, and so disorganized and sometimes so thinped as not to be as to be incapable of again uniting to the susceptible of adhering to the subjacent subjacent tissue. The disorganized tissues parts. The fourth period has no fixed du. are gradually thrown off, and the fundus ration; it depends on the extent of the of the ulcer is covered with granulations; loss of substance of the skin. When the the edges are softened, and the work of edges are much thinned, cicatrization is cicatrization proceeds. The cicatrix is long in taking place. always irregular and puckered, and for a Treatment.-- When anthrax is produced long time retains a brownish red colour. by external canses, is not preceded by de. If the anthrax have been very large, the rangement of functions, and is not large, cicatrix may tend to constrain certain no inconvenience will be felt by attemptmovements; but this may usually be pre- ing its resolution by means of a good vented by moderate care.
number of leeches applied to its surface, or Anthrax, such as I have described, even by the application of cupping glasses. benign in its character, is sometimes a Sometimes relief may be obtained by the fatal disease ; it may destroy life when application of cold; and the progress of very large-when seated in the walls of a the disease may be arrested. If, however, splanchnic cavity, the inflammation being the disease proceed from constitutional communicated to the serous surface. In causes, it may not be wise to employ the
latter means, as it may suddenly induce sometimes formed of irregular masses of gangrene. Emollient cataplasms are often fatty matter in certain regions, and pre. very fatiguing to the patient, and are, in sent no well-defined limits. In this case my opinion, useless, except as relaxing the borders of the tumor are insensibly agents : warm water would, therefore, do confounded with surrounding parts (libetter. Plasters, ointments, and greasy poma diffusum); it is remarkably soft, is applications, increase the burning heat. easily compressed, and is so adherent to the If we bear in mind that anthrax is essen. skin, that this latter presents scarcely any tially an inflammatory disease, that it only mobility, and does not present a complete terminates in gangrene because the cellular cyst. The adipose matter which it contissue is strangulated, we shall have dis- tains is similar in all respects to that of tinct ideas of the practice which should be the rest of the body, except that it is a followed: it was in consonance with this little firmer. That kind which exists be. principle that Lallemand made a circular tween the layers of the cellular tissue is incision which relieved the strangulation more deep seated, is generally covered and emptied the capillaries ; but this cir. with a layer of adipose matter, is perfectly cular incision will not do when the tumor circumscribed, very moveable, and elastic; is large, or situated in the vicinity of large and it is surrounded by a particular cyst. vessels and nerves. The crucial incision Usually the parietes of the cyst are thin; is much more advantageous; but to attain in rare cases they are fibrous, or even carthe end, the incision must be deep, and tilaginous. extend beyond the circumference of the In general we do not know the causes tumor. When the tumor is very large, it of lipoma; they now and then succeed 10 may be necessary to make more incisions. pressure, to a blow, or other violence; they Soon the suppuration becomes considera- are met with at all ages, in both sexes, most ble, and the poultice should be removed frequent, however, in adult life and in the three times a day. We must not extract female; and their most common seat is the with violence the sloughs, or we may pro- neck, the shoulders, or the back. It is not duce much pain and some bæmorrhage ; uncommon to see many of these tumors but, when hanging about, we may cut upon the same persons. them off with a scissors. If suppuration Treatment. These tumors constitute a be slow, it may be necessary to stimu. disease of importance, inasmuch as in some late with resinous or balsamic substances. cases they are developed very rapidly: If the digestive system be much deranged, When small, they sometimes seem to yield we may at first give an emetic and laxa- to counter-irritation; yet, as a rule, ablutives; during the period of acute inflamma- tion is the only treatment which promises tion, the patient should be carefully dieted. a speedy cure. The operation is simple If pain be violent, and no congestion or and easy when the base of the tumor is not constipation, we may give opium. When very wide, but it may offer difficulties, and suppuration is established, and fever has sometimes danger, when the tumor is very ceased, we must sustain the patient by large, when it is in the vicinity of importdiet and tonics.
ani organs, and when its prolongations extend far and wide. In such cases it is
sometimes impossible to remove the whole Lipoma.- Among the tumors developed of the morbid growth, and then the disease in the cellular tissue are some formed al. is reproduced. The extirpation of these most exclusively of adipose matter-lipoma. tumors should be done in conformity to These tumors are slowly developed, and certain rules; it should be done with a usually without attracting attention ; they bistoury: the incision should extend be. present to the touch a peculiar softness, yond the margin of the tumor, and the tu. which may be compared to that of carded mor should be dissected out with the cyst; cotton ; their surface is irregular, presents the lips of the wound should then be fairly knobs which are not hard, and which are brought together, and union by first inten. easily depressed. When they attain a cer. tion proceed. If the tumor be very large tain degree of development, their increase we shall sometimes fail in this; but we is often rapid, and their bulk may become oftener sail from leaving some portion of enormous. So long as the tumor is small, the cyst behind. the skin over it suffers no change; but when it is large the skin acquires a tension proportioned to its volume, the circulation, Under this denomination we include the is interfered with, the cutaneous veins are mores cystici, saccuti tunicati, cystiiles, lupice, distended, the skin inflames, especially &e., which are developed in the subcutawhen it is seated on a point where it is neous or interstitial cellular tissue. They exposed to friction or external violence. are characterised by a proper eyst, in the But lipoma may be seated also in the cavity of which a particular secretion is adipose tissue ; in this latter case they are made. Bichat demonstrated almost to evi.
dence, that this cyst, instead of being Treatment.—Many means bare been em. formed, as was previously supposed, by the ployed to cure encysted tumors; the choice thickening and distention of an areola of should depend upon the seat and volume cellular tissue, was constituted by a true of the tumor, its mobility, structure of the new product, which, in its nature and vital cyst, and the sensibility of the patient. properties, should be assimilated with se- Those various means are directed to rerons membrane. The consistency and the solve the tumor- to remove it completely nature of the matter accumulated within or partially with the histoury- to destroy these cysts have caused their division into it by the ligature-to incise, and destroy three varieties : serous (cystis serosa, bygro- the cyst by suppuration.
In some cases, ma); meliccric, in which the matter con- more than one of these means are comtained presents the consistency of honey; bined. atheromatous, in which the matter resembles To obtain th eresolution of these tumors, pap or panada:
frictions, with irritating Anids, blisters, The nature of the cyst is very various: caustics, and other similar means, have often they are hard, compact, fibrous; been used. In serous tumors, these means sometimes horny, or even osseous. The will often succeed in causing the absorpinternal surface is frequently smooth, tion of the fluid; but the lining membrane shining, sometimes villous; it may even remains, and in most cases the fluid is present bairs at its surface. In some the again secreted. To dissipate this tendency organization resembles that of a mucous the means must be continued long, blisters surface; sometimes it is reticular. The must be again and again applied. Sir B. adhesion of the cyst to surrounding tissues Brodie, in such cases, is accustomed to use, is not usually very intimate. At first they with decided success, a stimulant and era. are always very small, and slowly developed; porating lotion, composed of sp.camphorat. usually round, and their limits well mark- sp. tenuior aa. Ziii.; ss. liquor plumbi dia. ed; but their form may be influenced by cet. zi. This is kept constantly applied for surrounding organs. The sensation de. weeks, and even months. In some cases rived froin pressure varies with their con- no sensible effects are observed, other than tents: sometimes tense, elastic; sometimes a redness of the skin, for weeks; but still fluctuating; sometimes solid and resisting, it must be persevered with. the skin covering them being unchanged. Extirpation with a bistoury is in many Often, after acquiring a certain bulk, they cases the best mode of treatment, when the remain nearly stationary through life. position of the tumor admits of its removal Sometimes, without apparent cause, or in without much risk of injury to important consequence of external violence, they may organs. We must take care to so manage intlame, and the nature of the contents may the tumor as to allow of the lips of the in. then change, may become puriform; the cision being brought properly together, skin reddens, ulcerates, the cyst is opened, Whenever the skin covering is diseased and the contents are poured out. When when the tumor is very large-two ellipti. this inflammation is violent, the tissue cal incisions should be made, so as to leave forming the cyst may undergo great only the necessary quantity to admit of changes—may become granular, and be immediate union. cured; but, instead of this, it may remain The ligalure has been recommended, fistulous-may end in the development of where many and large vessels communifungous, or fibrinous, or albuminous mat. cate with it, and when the danger of hæ. ter within the cyst, and resist every kind morrhage may give fair cause for appreof treatment.
hension, or when a cutting instrument Another kind of tumor is particnlarly may endanger important organs. The manifested under the scalp, under the in- constriction is augmented from day to day leguments of the face, and ibe back. They until the strangulation is complete. I appear to result from the obstruction of bave never seen this mode of treatment one or several sebaceous follicles, whose employed. It is always long, causes acute cavity becomes greatly enlarged. Their pain, and, when the tumor begins to form is generally round, and sometimes slough, the odour is sometimes intolerable. they give a sensation of fluctuation. They The cyst may be opened, or it may be de contain a substance which is not very un. stroyed in various ways. Wben the adhelike cooked white of egg. They are usually sion of the cyst to neighbouring parts is adherent to the skin, and are sometimes not intimate, a longitudinal or crucial infilled with hair. The structure of these cision may be sufficient to empty it, when cysts is variable: in the face they are it may be stuffed with lint until suppuration usually thin; thicker on the back; but
We may open the tumor with most resistant on the head; and, usually, a lancet or caustic; and, for many days in the cyst is as much thicker as the tumor succession, irritate its internal surface, by has existed longer.
introducing foreign bodies, or touching the surface with caustic. By little and little