fluid and soft solids of the body, with which it is | which may modify their texture, and render them connected. 54. V. OF THE Medical TreaTMENT OF ABSCESS. The indications of cure which we propose in abscess is, 1st, to remove the purulent collection from the part containing it; and, 2d, to procure the obliteration of the cavity in which it was lodged. The first intention is accomplished either by procuring the absorption of the purulent matter, and its elimination from the body; or by opening the parietes of the abscess, and thus giving a direct outlet to the contained matter. When the means used to accomplish the absorption of the purulent matter fail, or when the character of the abscess and state of the frame forbid the employment of these means, opening the abscess must be resorted to when the proper period for having recourse to the measure arrives. susceptible of contracting the adhesions requisite to their obliteration. The majority of purulent collections which are removed by absorption, is such as form rapidly, without much previous inflammation, and in debilitated habits, or in those weakened by pre-existing disease. In persons of this description, the excitement or irritation of the kidneys, or of the mucous surfaces, will often overcome the irritation existing in the seat of abscess, and consequently promote the absorption of the pus it contains; at the same time that the fluid abundantly secreted by the parts artificially excited will assume, in consequence of the state of the patient, a puriform character. (DUPUYTREN.) But, in the majority of instances of this kind, it is necessary that the artificial irritation or excitement shall be greater than that previously existing in the seat of abscess, and that the organs or parts in which it is induced be in a sound state; otherwise the revulsion cannot be either successfully or safe of action of revulsants on abscesses of this kind, there can be no doubt that it is almost entirely in them, and particularly when they are seated in lymphatic glands, that we can hope successfully to employ this plan of cure. 55. 1st, Means which may be resorted to, in order to procure the absorption of the purulent matter, and its elimination from the frame.— Numerous instances have occurred of the rapidly practised. However we may explain the mode absorption of the matter contained in an abscess, and of its discharge from the circulation, 1st, by the urinary organs, the urine becoming abundant, and containing either a puriform secretion, or being otherwise altered; 2d, by the mucous surface of the bowels, attended with diarrhoea; and, 3d, by the cutaneous surface, in the form of a copious, thick, or viscid, and offensive perspiration. These are the most common channels of elimination of the purulent secretion, when absorbed into the circulation from the cavity of an abscess. The purulent collection may, also, disappear in consequence of other critical or accidental evacuations; but this result is of rare occurrence, and is a much more remote contingency than those enumerated. Experience having shown the possibility, and the great advantages, of removing the matter contained in an abscess by exciting absorption, the means most effectual in attaining this end should be first put in practice. 58. When the evacuations procured from the first passages, and from the kidneys and skin, have no effect upon the tumours, and particularly if the stomach and bowels seemed to support their action with difficulty, they must be abandoned, and recourse be had chiefly to the more direct means of cure. The local excitants, as iodine, the sulphureous douches, frictions with mercurial, camphorated, and terebinthinated liniments, and the repeated application of blisters for a short time, are only suited to the chronic kinds of abscess, where little or no inflammatory action exist. But these remedies should be watched, lest they increase the heat and inflammatory action of the external or superficial part of the tumour, and thus occasion their external opening. 56. With this view drastic purgatives may be prescribed, when the state of the patient admits of them; and next to them, such diuretics and diapho- 59. In the majority of abscesses, it is requisite retics, as may be appropriate to the circumstances to keep three facts in recollection: 1st, that the of the case. Contemporaneously with the use of inflammatory action in their parietes does not those internal derivatives, external applications cease on the formation of the purulent collection; should be employed, particularly those which pos- 2d, that an abscess is generally a complication of sess discutient, resolvent, and styptic properties. this inflammation, and of the retention of purulent Frictions with stimulating substances, as ammoni-matter in the inflamed parts which formed it, the acum, iodine, hydriodate of potash, &c.; cold, warm, or tepid affusions on the part, either of simple or mineral waters, of sulphureous or saline, natural or artificial, may likewise be tried conjointly with the internal means. But this energetic plan of treatment,-this combination of the revulsive and discutient practice, this methodus perturbatrix, is not applicable to all cases. There are many circumstances connected with the seat and condition of an abscess, and with the state of the different functions, that either altogether forbid its employment, or require important modifications and adaptations of it. 57. Thus, abscesses preceded by acute or active inflammation, are rarely susceptible of being absorbed; the opening of them, therefore, is almost inevitable. Chronic abscesses, which are generally provided with thick cysts, also admit not of removal by this practice; it being generally requisite to excite a new action in their parietes, inflammatory action being still present, although in a somewhat modified state and grade, and still continuing to form this matter; and, 3d, that the existence of pus does not necessarily or materially change the nature of the action which produced it. The therapeutical indications to which these facts necessarily lead are important, particularly as they show, what, indeed, has been proved by experience, that antiphlogistic remedies, especially those of local application, should not be laid aside with the supervention of suppuration. In the majority of cases, and particularly when increased heat of the part still continues, this class of local remedies should be employed with an energy in proportion to the activity of the local symptoms. As long as pain, redness, heat, and tension remain around the abscess, so long should leeches, or other modes of capillary depletion, directed to its vicinity, be had recourse to, particularly if the state of the patient offers no urgent indications against the practice. Emollient and astringent applications should also be constantly employed. These will generally reduce the inflamination of the surrounding tissue, favour the resolution of the parts not yet suppurated, limit the quantity of the morbid secretion, and favour the maturation of the abscess, so that it may be opened with the best hopes of success. In some cases, the use of these antiphlogistic measures will give rise to the absorption of the purulent matter, even after this had been attempted to no purpose by means of revulsives. 60. It should be recollected that the surfaces of abscesses are the constant seat of two kinds of action; one of exhalation or secretion, the other of absorption; and that whatever excites or irritates them increases the former, and whatever soothes or diminishes this irritation lessens it, and favours the latter action. This consideration should lead us strenuously to adopt a continued antiphlogistic and soothing treatment of the affected part, until the thinning of the skin at the most prominent part of the tumour indicates the necessity of opening it. 61. In symptomatic abscesses, the treatment should chiefly be directed to the primary seat of disease; for as long as the mischief continues or advances there, the purulent collection increases, and diminishes as it subsides. Thus, the abscesses that point near the anus or crural arch, in consequence of disease of the vertebræ, will sometimes disappear after the use of active means directed to the original malady, and judiciously adapted to the state of the patient. 62. Consecutive and spreading abscesses require a very different management from that now pointed out. These generally occur in persons of an unhealthy habit of body, or who have been weakened by acute disease; or they are the result of an adynamic or ataxic and spreading inflammation occasioned by a specific or poisonous agent; and they are not infrequently the consequence of the inflammation of veins, or of the presence of morbid secretions or purulent matter absorbed into the circulation, (§§ 25-28.), or of the transfer of irritation from a distant part. But from whatever cause they may proceed, and they may, and occasionally do, proceed from either of those sources,-deficient constitutional energy, and vital resistance to the influence of the exciting cause, with a marked disposition of the structures to be invaded by it, and to participate in the morbid action it excites, are their constant concomitants; requiring the energetic use of those means which are the best calculated to rouse the powers of the frame, to restore the deficient tone of the capillary vessels, and to thus enable them to form coagulable lymph, by which the spread of the local mischief may be limited. Instead, therefore, of having recourse to antiphlogistic remedies, the state of local action, and of constitutional power, requires a tonic, stimulating, and restorative treatment; conjoined with the means best calculated to promote the functions of all the abdominal viscera, so that morbid matters may be eliminated from the circulating current, and healthy nutritious elements conveyed into it; and with a pure air to perfect the changes which it undergoes during respiration, and which are requisite to the continuance of the functions of life. The treatment necessary in such cases is fully detailed in the articles on INFLAMMATION of VEINS, on SPREADING INFLAMMATION of the CELLULAR TISSUE, and on the treatment of ANIMAL POISONS. 63. 2d. Of opening abscesses.—When we fail in procuring the absorption of the puriform matter, its artificial discharge will, sooner or later, be required, when this can be accomplished. Certain abscesses require a more immediate performance of this operation than others, and more particularly the following:-1st, Abscesses proceeding from the escape, into the substance of any organ or part, of irritating secretions or excrementorial matters, as the urine, or facal substances. 2d, Abscesses preceded by very acute inflammatory action, and occurring in cellular or adipose structures, as the margin of the anus, the sides of the neck, or the groins. 3d, Purulent collections deeply seated, or confined under fascia or aponeuroses. 4th, Abscesses formed in the parietes of the splanchnic cavities, in order to prevent the chance of their breaking internally. 5th, Abscesses formed in parts through which large nerves and blood vessels pass, and on which the purulent matter occasions a painful and injurious pressure; as abscesses in the neck, and underneath the sterno-mastoid muscle, at the top and inside of the thighs and arms, &c. 6th, Abscesses which embarrass the respiratory organs, and which press upon the larynx, pharynx, or trachea, or which endanger the integrity of those parts. 64. In all these the strict antiphlogistic treatment will be requisite, unless they are of the diffusive or consecutive kinds, with emollient applications, in order to limit the extent of the inflamed parts, to diminish their size, and to hasten their maturation; and in many cases this mode of treatment must be continued for a considerable time after the discharge of the matter, in order to limit or prevent its re-accumulation, and to promote the collapse and diminution of the parietes of the abscess. The cases where it will be frequently necessary to retard the period of discharging the purulent collection, are chiefly those in which it is formed in the internal viscera, as the liver, spleen, kidneys, lungs, &c.; respecting which I have treated fully under their appropriate heads. 65. Chronic abscesses should be opened as soon as it is shown that their absorption cannot be accomplished; or when they augment in bulk under the discutient and derivative treatment. Symptomatic abscesses also require to be opened, when we find that the means which we have directed to the original seat of disease fail of limiting their extension, or lessening their bulk. Consecutive abscesses require to have their contents immediately discharged, when their situation admits of this being done; for the morbid state of the matter they sometimes contain, and the weak vital resistance opposed by the surrounding parts, and by the constitution, favours the contamination of the adjoining structures, and, indeed, of the whole frame. But this intention can seldom be fulfilled, owing to the seat of the purulent collection; and, when it is put in practice, it should be followed by as complete an exclusion of the atmospheric air as possible. 66. It does not come within the scope of this work to notice, at this place, the different modes of opening abscesses, and the treatment with which the operation should be accompanied and followed. This necessarily differs in every case; but that part of it which belongs to my province is stated at the place where abscesses in the different viscera are discussed, and the means which may be employed to procure the obliteration of their cavities, the second intention of cure, are noticed, with reference to abscess of each of the important viscera and structures in which it is liable to form. BIBLIOGRAPHY.—Stahl, De Abscessu et Furunculo, Ħale, 1714. — Latxig, De Abscessu Latente, Lips. 1758, 4to.- Meyer, De Abscessu in Febribus, &c., Got. 1759. -Streeter, De Puris ab que prægressa inflammatione Origine, Got. 1766-Bordinare, De Abscessu Abdominis, &c Paris, 1774-Frey, De Apostematibus, Lips. 1775. -Darwin, Experiments on Mucilaginous and Purulent Matter, Litchf. 1780. — Salmuth, De Diagnosi Puris, Got. 175-J. Hinter, On the Blood and Inflammation, Lon 1. -Home, Dissert, on the Properties of Pus, Lond. 1788. -Jastamond, Versuch. üb. d. Entzundung. &c., Leip. 173).—Widekind, Allgem. Theoried. Entzundungen, Lep, 1791. — Dupuy, Sur les Abces, ou Tumeurs rulentes, Paris, 1894. —Lassus, Pathologie Chirurgicale, Li, Paris, 1803, 8vo. — Pearson, Observat. on Pus, Philosoph. Trans., Lond. 1811.-Rust, Uber Abscesse, in demen Magazin, b. i., Berl. 1816 - Thomson, On Inammaton, Edia. 1823, ch. 9.-Heurtle loup, In Dictionnaire des Sciences Médicales, t. i. et t. viii. p. 431.- Richter, at. Abscess, Encyclopid. Wörterbuch der Medicinischen Wiesenschaften. b. 1., Berl. 1823 — Rour, art. 4b es, in Deionare de Médecine, t. i p. 4. — Dupuytren, art. Ace, a Dictionnaire de Médecine et de Chirurg. Pra tques, t. L.Paris, 1829. ABSORPTION. SYN. Absorptio, Lat. Absorption, Fr. Die Einsaugung, Ger. Assorbim ento, Ital. CLASSIF. GENERAL PATHOLOGY and THERAPEUTICS. This is one of the most important functions in the system, and one of the most frequent channels through which disease is caused, perpetuated, or removed. As to each of these relations it requires a brief notice. severity. The first class invade the system on the mucous and cutaneous surfaces, the skin, the lungs, the alimentary canal, &c.: the second class form in the parenchyma or texture of organs and parts, or are generated on secreting surfaces, whence they are absorbed into the circulation. On each of these I shall offer a few remarks. 3. 1st. Of absorption on the skin in relation to the production and removal of disease. - a. That disease frequently proceeds in this way is evinced by certain contagious and chronic affections of the skin itself: that it is possible to produce various derangements, by applying to it several active agents, which affect this surface no further than in being absorbed from it, may be proved by direct experiment. But it is chiefly when the skin is deprived of a portion of its cuticle, however minute, that we perceive affections produced through the medium of cutaneous absorption. Several eruptive and contagious diseases are familiar examples of this; and the majority of deleterious agents produce a most decided effect when applied to the skin thus exposed. 4. b. The same channels through which disease invades the system, are often the most suitable through which to counteract or remove it. This is shown by the treatment of syphilis; by the use of baths, lotions, fumigations, and inunctions in cutaneous and visceral affectious; and by the employment of various remedies to the skin, which are partially absorbed from it into the system. When the skin is deprived of a portion of its cuticle, it absorbs rapidly many of the most active agents employed in medicine; and it is thus rendered one of the most eligible situations to which we can direct our plan of cure. Thus, when the stomach will not retain the sulphate of quinine, it may be efficaciously administered to the denuded cuticle; or when we wish to produce an anodyne effect upon the system, or to assuage violent pain, the preparations of morphine, as the acetate, may be applied in this way. And in various diseases, when the function of deglutition is lost, or the mouth cannot be opened, certain active remedies may be thus administered; more especially those which operate their effects after having been absorbed into the circulation. Even purgatives, as the croton oil, and elaterium, some preparations of iodine, strichnine, prussic acid, tartar emetic, &c., if judiciously employed in this way, will be often productive of advantage, and are not infrequently required to be thus prescribed. 1. OF ABSORPTION IN RELATION TO THE CAUSATION, PERPETUATION, AND THE REMOVAL OF DISEASE. -The importance of entertaining accurate ideas as to the channels through which noxious agents affect the system, must be manifest. Without them, many of our pathological doctrines must be erroneous, and the therapeatical indications founded on them worse than useless: on the other hand, just views as to the nature and extent of the causes which operate through this medium, give rise to the most important inductions, — the chain of morbid causation is traced without interruption, the nature of pathological conditions is more accurately observed, and ultimate effects are recognised in due connection with remote causes. tical advantages which accrue are great: prophylactic measures are based on sound princi-a. ples: remedial agents are directed with precision; and the physician prescribes in a spirit of rational induction, instead of blind empiricism. The prac 2. The agents which affect the system injuriously through the medium of absorption consist, first, of those which are external and foreign to the body, and act upon it only occasionally, or under certain circumstances; and, secondly, of those which are generated in the body itself, and, when carried by means of absorption into the current of circulation, produce very important effects. The former rank among the primary causes of disease; the latter are themselves the result of disease, but become important secondary causes, perpetuating and generally increasing its 5. 2d. Of absorption from the lungs in relation to the causation and removal of disease.- There are very few, if indeed any, of the numerous maladies which are usually denominated infectious, that are not caused through the medium of the lungs. And, though the greater proportion of them are most probably induced from the morbid impression which their exciting causes make upon the nerves supplying this organ, yet several of them are also, more or less, occasioned by the absorption of the cause itself into the circulation, and by its influence upon the blood, and the nervous and vascular systems. Probably, also, certain other causes of disease, of no mean importance, particularly marsh miasmata, and noxious animal exhalations, act directly upon the organic nerves of the lungs, and on the blood itself, through the medium of absorption. We 24 ABSORPTION-ITS PATHOLOGICAL RELATIONS. have reason, moreover, not only to infer that the more material causes of disease are absorbed from the surface of the lungs, when inhaled into them with the atmosphere, in the moisture of which they are dissolved, or otherwise combined; but also that the foreign gases, which sometimes mix with the air, act in some measure through the same channel. depression of the powers of life, or which rapidly 6. The organization of the respiratory surfaces, the nature of the circulating functions on these surfaces, and the more immediate relation subsisting between the air in contact with, and the blood circulating in, them, will readily explain the rapi9. d. The knowledge that we thus acquire redity with which foreign matters floating in the atmosphere are frequently conveyed into the circulation. Besides, we have strong reasons to infer specting the channels, through which the causes that several of the gases, and of the soluble sub- of many diseases invade the system, and the restances which float in the air, are carried directly medies for removing them may be efficaciously into the blood from the surface of the lungs, with- administered, furnishes us with important indicaout passing along absorbent vessels. The experi- tions as to the employment of prophylactic meaments of Professor MAYER, and of Drs. Law-sures, and rational plans of regimen and hygiene. RENCE and COATES, as well as those of MM. Miasmal or contagious fevers furnish us with nuSEGALAS, FODERA, &c., fully confirm this in- merous opportunities of proving the justness of ference; whilst those performed by MM. MAGEN- these views. Observation shows us that the DIE, SEILER, FICINUS, TIEDEMANN, GME- causes of this class of disease act upon the system LIN, and several others, show, that even in the al- chiefly from their presence in the air we breathe: imentary canal, and especially when capillary ves- it further enables us to decide that these causes sels are divided in any of our tissues, the function invade the system chiefly through one of two, or of absorption is not confined to lacteal or lymphatic perhaps by both, routes; viz. by the nerves supvessels, but is frequently extended to the venous plying the respiratory organs, or by the partial capillaries, which, in respect of certain substances absorption of the causes themselves, from the particularly, chiefly perform this function. Hence pulmonary mucous surface, into the circulation. I may conclude that foreign substances dissolved From the same source, or from the collateral eviin, or combined with, the moisture of the air, or dence of experiment, we know that foreign submixed with this fluid, may, when inspired, be car- stances do not so readily enter the circulation, ried from the surface of the lungs into the blood, when its functions proceed with energy, and the independently of the absorbent vessels; although, vital resistance is perfect, as when they act feebly of disease have less power over the nervous indoubtless, these vessels perform their appropriate and imperfectly; and that the depressing causes functions in this as in other parts of the body. fluence of the respiratory organs, and of the system in general, when the vital actions which take place in the lungs are performed with due activity. The same sources of observation make us acquainted with the important facts, that the dilution of the atmosphere, which contains the causes of febrile diseases floating in it, by free ventilation; that the destruction, or neutralization, or of certain disinfectant and stimulating agents; and counteraction, of these causes, by the evaporation that a due energy of all the vital and secreting functions, with an equable state of the mental powers and manifestations, and with a steady confidence; are the most successful means of preventing the attack and diffusion of those maladies. 7. b. The rapidity of absorption in the lungs, and 8. c. Through this channel a number of fevers, 10. By combining these facts as to the source, mode of operation, and methods of counteraction, of the chief causes of a most important class of maladies, and by directing the measures they suggest as far as may be according to the peculiarities of individual cases and diseases, we are thereby enabled to furnish persons, and even whole communities, with instructions and means calculated either to counteract or to lessen the dangers to which they are exposed. 11. 3d. Of absorption from the alimentary ca-a. It may be received as a pathological axiom nal, in connection with the causation of disease matters are absorbed from the digestive mucous that the rapidity and extent with which deleterious surface, as well, indeed, as from the respiratory, and other organs of the body, are nearly in pro portion to the depression of the nervous ener-perfect,—of the remedies which act by being abgies and vital resistance of the system. The sorbed, either altogether or in part, from the alitruth of this is evinced in respect not only of mentary canal. Most of those substances which the actions proceeding on the mucous surfaces, are found by experience the most efficacious in but also of those taking place in the different promoting the actions of the different secreting organs and structures. It is necessary to allude viscera, and in producing a marked and permahere to the numerous agents which cause, coun- nent change of the general state and functions of teract, or remove disease, by their being absorb- the economy, operate after having been absorbed ed from the alimentary canal. Whilst many into the circulating current, and conveyed through agents produce their effects chiefly by modifying this channel to vital and secreting organs; and, the states of the nerves and mucous tissue of although, during the healthy performance of the this canal, others act principally from being ab- secreting functions, or whilst the vital energies sorbed, either by the lacteals, or by the venous are not far reduced, these substances seldom accuradicles, and carried into the circulation; and a mulate in the blood so as to be detected in it by still more numerous class seem to operate through chemical analysis, owing to the balance which is both channels, impressing immediately the nerves preserved between the rapidity of absorption and and tissues to which they are applied, and subse- the activity of elimination, yet their passage quently being absorbed into the blood, where they through it is proved by the fact, frequently obproduce important effects not only upon this fluid, served in regard of all of them, of their being and on the vascular system, but also upon the found in the secretions of the eliminating or defunctions of various secreting organs, especially puratory organs. This fact was established by exthose by which they are eliminated from the body. periments performed by myself,-some of them 12. A very large proportion, therefore, of the as far back as 1819,-and published in several ingesta, whether alimentary, medicinal, or poison- periodicals in 1821 and 1822. ous, thus acting upon the system chiefly through the medium of absorption, the importance of directing a considerable portion of attention to this function in our pathological investigations, as well as in the appropriation of medicinal means, must be apparent. Besides these more obvious relations of the subject, there are others which have been either imperfectly investigated or entirely overlooked. To these I can merely allude: but amongst the most interesting are the absorption of anwholesome and imperfectly digested chyle from the intestinal surface; the absorption of a portion of the vitiated secretions which occasionally accumulate in the alimentary tube, particularly in the Cecum and cells of the colon; the absorption of some part of the fecal matters, when they are long retained in the above situation, as evinced by the sensible qualities of the perspiration, foul state of the skin, &c., or of the obstructed and accumulated urinary secretion, as proved by similar phenomena; the passage of bile into the circulation, when it has been retained in the liver, the biliary ducts, or gall-bladder, from torpor or obstruction of these parts, or when it is secreted in large quantity, and does not readily pass off with the egesta. All these are very fruitful sources of disease; and, although generally connected with some degree of pre-existing disorder, or of torpid function, they are often the chief aggravating causes of many of the maladies we are called upon to treat, from the constitutional and visceral disturbance they occasion and perpetuate. 13. There are few disorders which implicate the digestive and chylopoietic organs, and very few febrile diseases, which do not, at some period of their course, evince signs of the absorption into the circulation of a portion of the morbid secretions or fæcal fluids retained in the alimentary canal, when due evacuations are not practised. Therefore, besides the other effects produced by medicines of this class, the due evacuation of these secretions and fæcal matters from the prima via is one of the best offices they perform. 14. b. It is unnecessary to do more than to allade to the advantages that accrue to the scientific practitioner from some knowledge, although, in the present state of medicine, necessarily im 15. 4th. Of absorption from diseased organs and structures.-a. When morbid secretions are generated, or accumulated in any organ or texture, or when any part is changed in such a manner as to secrete a matter different from the healthy constituents and fluids of the body, the matter formed is generally, after a while, absorbed into the circulation, and contaminates, in a more or less marked manner, according to its nature, the other fluids, and the soft solids, and thereby at last destroys life. Illustrations of this procedure are furnished us in the pathological history of internal and deep-seated abscesses; in some morbid states of the uterus; in scirrho-cancer, fungous hæmatodes, and other malignant diseases. The celerity with which the absorption of the morbid matter and the contamination of the frame proceed, is generally according to the principle already recognized (§ 9.),-in proportion to the diminution of the vital energy and resistance of the constitutional powers. 16. b. The commencement of the contamination can scarcely be determined by an appreciation of symptoms: but the experienced observer will readily recognize, in the colour of the surface of the body; in the state of the heart's action, and of all the circulating functions, as well as in the blood itself; in the failure of the energies of life; in the morbid condition of the nervousnctions and of the powers of the stomach, and indeed of the whole digestive canal, sufficient proofs of the early, as well as of the advanced progress of disease, arising from the absorption of morbid matters from the primary seat of morbid action, and the consequent vitiation of the circulating fluids, of the soft solids, and of the secretions and excretions of the body. (See Art. BLOOD.) 17. In many of the more chronic diseases which either commence with or terminate in the malignant state, this contamination is frequently first evinced by the tumefaction and pain of adjoining lymphatic glands, owing to the irritation produced by the morbid fluid conveyed into them: the inflammation or obstruction thus produced in them becoming an obstacle to the rapid transit of the morbid matters from the original seat of disease into the circulation. But in many cases this |