prurigo are flattish and of the same colour as the skin, while the vesicles are acuminated and rose-coloured. The vesicles of the latter terminate in yellow scabs, and occur in exactly opposite situations to those in which prurigo appears, namely, in the internal surfaces of the limbs and in the line of flexion. The pruritus of scabies is also much more supportable than that of prurigo.-(c) Prurigo may co-exist with lichen, scabies, and eczema, and with the pustules of impetigo and ecthyma. It terminates by resolution or by furfuraceous desquamation. 9. III. PROGNOSIS.-Prurigo is not attended by danger in the young, robust, or otherwise healthy, although it may prove very obstinate and harassing to the patient. In debilitated, cachectic constitutions; in old and ill-fed persons; and where cleanly habits are not duly observed, it is often incurable; and if it be associated in these with visceral disease, it may tend to shorten life. In the complications especially, and particularly in those with disorder of the abdominal organs, either the suppression of the external eruption, or the development of acute disease of these organs, may be attended by severe or dangerous symptoms, especially if the eruption disappear rapidly. functions of the skin should be restored by a frequent use of warm alkaline, or of soap, or of sulphur baths; and by the internal administration of sulphur with magnesia, or with an alkaline carbonate, every night, or both night and morning. When the skin is dry and rough, these baths may be alternated with vapour baths, or with baths containing the bi-borate of soda, and followed by warm baths with gelatin or mucilaginous substances, as tragacanth, two or three days being allowed to elapse after the mucilaginous baths in order to observe their effects. These last baths may likewise contain either of the alkaline sub-carbonates, from one to four ounces to each bath, according to the size and age of the patient. Where the skin is delicate and irritable, then irritating baths and applications ought to be avoided; simple warm or soap baths, or gelatinous, emollient, or mucilaginous baths being most serviceable. If these fail, the state of the assimilative and excreting viscera should be strictly examined, in order to detect lurking disorder; for generally to this cause is the obstinacy of the complaint owing, and to it, also, are to be imputed the injurious and often dangerous consequences of suppressing the eruption before, or without, attending sufficiently to the states of the abdominal functions and organs. 10. IV. CAUSES.-The first and second varieties of prurigo occur chiefly in children and adults, and at all seasons, but more frequently 12. Various ointments and greasy or oily in spring and summer. Senile prurigo is most applications have been recommended for this common in the old, ill-fed, and in connexion eruption, especially those containing sulphur, with an impoverished or impure state of the the iodide of potassium, and muriate of ammoblood. Low and damp situations; poverty, nia; but independently of the unpleasantness and the want of cleanliness; unwholesome, of such applications to an extensive surface, deficient, or poor diet; the use of salt, stale, they soon become, owing to the action of the or dried, or otherwise preserved fish, or of air upon them, more or less irritating, although shell-fish; heating and stimulating liquors and they may at first have afforded a little ease. condiments; impaired excreting functions, es- If they be at all prescribed, they ought to be pecially by the liver, bowels, kidneys, and skin; followed, in eight or ten hours, by a warm sathe neglect of aperient or chologogue medi- ponaceous or emollient bath. Instead of these cines, and of due evacuations; visceral disor-I have generally employed a lotion with the ders occasioning, or even consequent upon, the hydrochlorate of ammonia; or a very weak soaccumulation of effoete materials in the circu-lution of the bi-chloride of mercury, with or lation; the suppression or interruption of various depurative functions, as amenorrhea, &c.; the use of dirty clothes, or of foul woollen bedclothes, and of foul or impure beds, stuffed with animal productions, as wool or feathers which have become contaminated by the perspiration of many years of occupation; the influence of mental emotions, and interruptions of the excreting functions, severally and in various states and forms of association and succession, occasion this and various other chronic eruptions. 11. V. TREATMENT. In all cases, especially the more protracted, of this complaint, the state of the abdominal viscera, and of the several excretions should be closely examined, and existing disorder of these corrected or removed. -A. If abdominal plethora or congestion of any of the abdominal viscera be present, a moderate vascular depletion may be prescribed; and PLUMMER'S pill with soap be given at bedtime, and an aperient in the morning, consisting of the electuary of senna with magnesia and milk of sulphur. A dose of a bitter infusion, as calumba or chereita, may be taken once or twice daily, with the sesquicarbonates of potash and ammonia. Having removed accumulated or morbid excretions, and promoted the discharge of effœte materials from the blood, the healthy without the vinum opii, or watery extract of opium; or a solution of the sulphuret of potash; or a solution of the bi-borate of soda, or chlorate of soda or potash, or of the alkaline sub-carbonates, or diluted pyroligneous acetic acid, with the addition of creasote. These are severally beneficial; and while camphor-water, rose-water, or elder-flower water may be used as the vehicles of the active agents, opium, or hydrocyanic acid may be added, according to the circumstances of the case. In the more obstinate cases, I have prescribed, after due attention to the abdominal functions and organs, a weak solution of the iodide of potassium, with a watery solution of opium, as a lotion, and sometimes also this iodide or the iodide of iron internally, with sarsaparilla or with taraxacum, and have observed much benefit accrue from the treatment. 13. B. The senile variety of prurigo will gen erally be removed, if it be capable of removal, by the means above recommended, especially if due attention be paid to the states of the sev eral excreting viscera, and to diet and regimen. The utmost cleanliness should be observed. and as there is often not only debility, but als anæmia, or an impoverished state of the blood, in these cases, tonics and chalybeates should be associated with carbonate of ammonia, of with either of the other alkaline carbonates in | flower water, either with or without the addithe treatment. The patient should sleep on a tion of the vinum opii, or of the pure acetic hair mattress; and the bowels ought to be duly acid, or of both. regulated by means of sulphur with magnesia, or of any stomachic aperient which may be found to agree the best, as the infusions of gentian and senna with the sesquicarbonates of ammonia and of soda. 14. When the eruption is associated with the production of pediculi, a tonic treatment is more especially required, aided by cinnabar fumigations, or by frequent sulphur baths, or by lotions with the bi-chloride of mercury. A trial, in the most obstinate cases, may be given to mineral waters, especially when the excreting organs are torpid. The waters of Cauterets, or of Bonnes, or of Bareges, or of Carlsbad may be taken. Of these the Bareges water may be preferred; but I believe the sulphureous waters of Harrogate, or of Gilsland Spa, or of Moffat to be equally, if not more beneficial in this complaint, aided by warm bathing, due exercise, and appropriate diet. While the diet is sufficiently nutritious, it ought to be digestible; and fish, shell-fish; pork, veal, ham, bacon; heating condiments and rich sauces, coffee, and stimulating beverages should be avoided. BIBLIOG. AND REFER.-Hippocrates, Aphorism., sec. iii., aph. 31; Epidem., 1. v.-Mercuriali, De Morbis Cutaneis Libri duo; et De omnibus Corporis Humani Excrementis fectibus, 1. i., cap. 14. (First distinguished Pruritus into Libri tres, 1. ii., cap. 3, p. 62.-Hafenreffer, De Cutis Afgeneral and local.)-Willan, Description and Treatment of Cutaneous Diseases, 4to. Lond., 1798, art. Prurigo.— Sommer, De Affectibus Pruriginosis Senum. Altd., 1727. -Loescher, De Pruritu Senili. Wittemb., 1828.-Alibert, in Nouvelle Biblioth. Médicale. Mai, 1825.-Wilkinson, Remarks on Cutaneous Diseases, 8vo. Lond., 1832. (Adduces a remarkable Case of.)-Mouronval, Recherches et Observations sur le Prurigo, 8vo. Paris, 1825.-Elliotson, in London Medical Gazette, vol. xi., p. 34.-Alibert, in Medico-Chirurg. Review, vol. iii., p. 779.—Ruan, in North American Medical and Surg. Journal, 1828; and in Journ. paiba and Bi-borate of Soda for Prurigo Vulva.) See, des Progrès des Sc. Med., t. xiii., p. 264. (Balsam of Coalso, the works of Bateman, of Alibert, of Green, of Plumbe, of Dendy, of Rayer, of Willis, of Cazenave and Schedel, and of Wilson, on the Diseases of the Skin. PRURITUS-SYNON. Hyperesthesia cutis Itching, morbid sensibility of the skin-Prurit, Démangeaison, Fr. Das Jucken, die Reitzbarkeit, Germ. CLASSIF-III. CLASS, I. ORDER. (Author in Preface) 1. DEFIN.-Itching over a greater or less extent of the cutaneous surface, or limited to a particular part without any perceptible eruption, and generally symptomatic of some internal disorder. 15. C. The local varieties require chiefly the means already noticed. — (a) Prurigo podicis and P. scroti are often connected with chronic irritation of the rectum and of its mucous folli- 2. Pruritus, more or less general, is usually cles, owing either to the presence of ascarides symptomatic of disorders of the digestive oror to hemorrhoidal affection. In these cases, gans, or of some irritation of the digestive casmall injections of some of the lotions above nal, especially intestinal worms. In these camentioned into the rectum; great attention to ses, the irritation of the mucous surface is propcleanliness; the treatment, local and general, agated to, or reflected upon, the extremities of advised for these diseases; the application, by the nerves supplying the skin. The itching is means of a sponge, of the lotions already enu- often annoying, and is generally remittent; but merated (§ 12), or of a weak solution of the ace- it often continues in this form for many months. tate of lead with vinum opii, especially imme- It is exacerbated by the same causes as those diately after each stool; local fumigations with which increase prurigo, especially by changes sulphur or cinnabar, and an occasional applica- of temperature, by stimulants and heating contion of leeches in plethoric persons, will sel- diments, by hot spices, by opium, and by directdom fail to remove the complaint, which, how-ing the attention to it. In some idiosyncrasies, ever, is very prone to recur, after neglect or errors of diet and regimen. various articles of diet or of medicine occasion it; and then it usually continues only for a short time. Shell-fish, or fish of any kind; smoked, dried, or preserved meats, &c., sometimes cause it. It is not infrequently a symptom of disorder of the uterine discharge of hysteria; of the slighter states of irritation of the spinal chord or membranes, and of several eruptions. 16. (b) Prurigo pudendalis being sometimes occasioned by disordered catamenial functions, or by leucorrhoea, or by pregnancy, and complicated with either of these, requires an especial reference to the existence or non-existence of either. In these cases, the internal, external, and dietetic means already specified are of more or less service; but in these complica- 3. i. The local or limited states of pruritus or tions they may all fail, and the patient be re- itching may arise from the same causes as duced to a state of great misery. Treatment those now mentioned, but they much more often fails during pregnancy, although the com- frequently proceed from others more immediplaint will generally disappear after delivery. ately connected with the seat of itching. In In some cases it has recurred in each pregnan- most instances, however, of local pruritus there cy, and has even reappeared after the change is more or less functional disorder of the diof life. The application of leeches to the vul- gestive organs, or accumulation of fæcal or exva; cooling aperients and enemata, and cool-crementitial matters.-(a) Pruritus nasi is ofting and detergent injections per vaginam, or similar lotions to the vulva, are commonly of use. It is not rare to find this variety associated with one or more small boils of the labia majora, and in these cases the lead lotion with vinum opii will remove the affection at any early stage, and poultices or warm fomentations afford relief at a more advanced state. Prurigo vulva has generally disappeared, after the use of a lotion consisting of a saturated solutionf the bi-borate of soda in rose or elder en sympathetical of intestinal worms, and even of ascarides in the rectum, or of fæcal collections in the large bowels, or of dyspeptic disorders.-(b) Pruritus urethra is often a very troublesome affection. Itching of the extremity or course of the male urethra is most frequently caused by calculus or gravel in the bladder, or by irritation of the prostate gland or stricture of the urethra. In females it is connected either with calculus in the bladder, or with leucorrhea or uterine disorder.—(c) Pru ously, but often becoming severe, and extending to the hip, thigh, and knee-joint, caused by inflammation and suppuration, the pus collecting around the muscles, and descending with more or less tumour, either under POUPART's ligament or in some other direction. 2. ii. PATHOLOG.-Inflammation of the cellular tissues surrounding the psoa lumbar and adjoining muscles, generally originating in caries of the bodies of the vertebra, or in inflammation of the intervertebral substance, the muscles themselves ultimately becoming disorganized, and the purulent ritus vulva is often a most distressing affection. It is seated chiefly in the labia majora, but it frequently implicates the clitoris and nymphæ, or even extends up the vagina. It is usually caused by ascarides in the rectum, by disorder of the catamenia, by leucorrhoea, by self-pollution, and by hemorrhoids. It is not uncommon during the periods of puberty and the cessation of the menses, and especially during pregnancy. (d) Pruritus ani is often a very troublesome and obstinate complaint, and is most annoying soon after retiring to rest. It is usually caused by ascarides in the rectum, by hem-collection gravitating in the course of the cellular orrhoids, by fistula ani, by neglect of cleanly tissue, and opening or forming a tumour as above habits, by morbid states of the intestinal secre- and as hereafter stated. tions, especially of the mucous follicles of the rectum, and by irritation or congestions of the prostate gland and vesiculæ seminales. It is often complained of by persons of sedentary occupations and habits, and by those who sit on soft and warm cushions. The itching, although occurring independently of any visible eruption, when repeated or protracted, often occasions slight excoriations and thickening around the margin of the anus. 4. ii. Diagnosis.-Pruritus can be confounded only with prurigo, from which it is distinguished by the absence of any visible eruption, unless such redness, or excoriation as may result from scratching, and the mechanical irritation employed to remove or relieve this annoying sen sation. 5. iii. Treatment.-This should be directed to the removal of the morbid condition of the viscera, upon which the pruritus depends. This is most effectually accomplished by occasional doses of spirits of turpentine and castor oil, and by enemata of the same, so as fully to evacuate all accumulated or morbid matters from the bowels. Afterward the lotions I have prescribed for PRURIGO ( 12), especially the lead lotion with opium; diluted vinegar or lemonjuice with creasote; a weak solution of bichloride of mercury with some hydro-chlorate of ammonia; or the solution of the biborate of soda. Attention should be directed, in the treatment of the pruritus of females, to the state of the uterine functions, which ought to be duly promoted; and when congestion of the uterine organs, or of any of the abdominal viscera, is present, especially if the patient be young and plethoric, or if the parts become hot or excoriated, then local depletions, followed by hot fomentations, are required. The diet, regimen, and treatment are in most respects the same as advised for PRURIGO. 3. I. THE CAUSES of Psoas or lumbar abscess are, the scrofulous, the rheumatic, and the gouty diathesis; a cachectic habit of body, tubercular changes or deposites in the bodies of the vertebræ; caries of the vertebræ, especially the lumbar; inflammation of the intervertebral substance; violent exertion of the lumbar muscles, external violence, severe strains, or sudden jerks or twists of the loins; currents of cold air on the back or loins; and ulcerations of the cæcum extending to the peri-cæcal cellular tissue. Caries of the dorsal or lumbar vertebræ, or inflammation of the intervertebral spaces are the most common causes of psoitis and lumbar abscess. Of nineteen cases detailed by ABERNETHY, only two were independent of disease of the spine. He observes, that the general opinion of surgeons, in which he entirely concurs, is, that lumbar abscesses most frequently arise from diseases of the vertebræ ; and they should certainly all be treated as if such were their origin. 4. II. SYMPTOMS.-Psoitis sometimes occurs suddenly, and the patient complains of pain in the loins, especially on one side. Walking becomes troublesome; the thighs can be neither raised nor extended without pain. The disease sometimes commences gradually, with pricking pains, which, becoming more severe, extend to the hip, and to the thigh, and even to the kneejoint. Sometimes the progress of inflammation is so insidious as hardly to be noticed, until the mischief appears in the form of a purulent collection. According to the extent of vertebral disease and the degree of inflammation does suppuration appear early or late; but the abscess which is formed generally assumes a chronic state, and is of a symptomatic character, as it is consecutive of inflammation and caries of the vertebræ. The chronic abscess, termed psoas or lumbar abscess, commonly forms in consequence of disease of the vertebræ of the back or loins. Matter is secreted around the diseased vertebra, and then descends through the loose cellular tissue covering the muscles along the side of the pelvis into the thigh. It may take a course towards the back, or may go in various directions either within or without the pelvis. The pus formed about the seat of caries remains there for a longer or shorter time, especially in the cellular tissue. As the pus collects and increases it forms a cyst, which descends, and lengthens as it inclines to either or to both sides of the vertebral column. As the pus accumulates it pushes onward the lower end of the cyst, which, if it meet with any ob1. DEFIN.-i. NOSOLOG.--Pain in the loins, gen- stacle, spreads out, but contracts when pressed Wally on one side, commencing and existing insidi-on by the adjoining parts, and dilates again ., BIBLIOG. AND REFER. - Oribastus, Morb. Curat., PSOE MUSCLES-INFLAMMATION AND SUP- CLASSIF.-III. CLASS, I. ORDER. (See Pref- when relieved from pressure, until it at last | of larger size than femoral rupture, and the arrives at the place, when it projects or breaks. fingers cannot be at all thrust around it, as they In the route which the purulent matter thus partially may behind the hernial sac. The takes, the psoæ and other lumbar muscles are chief distinctions, however, are the long coninflamed, pressed upon, partially absorbed and tinuance of pain in the loins previously to its disorganized, owing to the extension of the in-appearance, the persistence of that pain, and flammation and purulent infiltrations to them and their connecting cellular tissue. the remarkable increase of pain produced by attempting to extend the thigh, especially backward, or the entire inability to do so. "When the abscess appears in the loins, there is no difficulty in determining its character by its history, and by its dilatation on coughing. Pulsation may sometimes be communicated to it from the adjoining large vessels ;" and thus it may be mistaken for aneurism, if the history of the case and the existing symptoms be not attentively investigated. 5. The abscess most frequently protrudes below POUPART'S ligament, and it generally extends or opens at a greater or less distance from the original seat of disease. It may, however, point or open into the cæcum, into the colon, or the rectum, or in some part of the back, or in the loins just above the sacrum; or it may make its way to the hip, or the groin, and proceed even down the thigh in the direction of the large vessels. As the matter is seated behind 8. (c) The diagnosis between psoas abscess the peritoneum, and as it generally gravitates and disease of the hip-joint is not always, alaccording to the position of the body, it very though it is frequently, easy. It has been well rarely perforates this membrane and becomes pointed out by Mr. COULSON (On Disease of the effused into the abdominal cavity. As the Hip-joint, 4to, Lond., 1837, p. 72), and nearly as purulent matter increases and presses upon, follows: 1st. In psoas disease, the patient genor otherwise implicates, or even inflames the erally complains of dull or of severe pain in the larger veins, nerves, or arteries, so are the loins, which is increased by the upright posture, symptoms either of phlebitis, or of neuritis, or and by every motion of the limb, particularly of artereitis, according to the situation and ex- on extending it: in diseased hip there is no tent of the abscess, not infrequently superin-fixed pain in the loins; it is felt more in the duced, and complicated with the advanced prog- vicinity of the hip, and especially in the knee. ress of the disease, in addition to the primary 2d. In the whole course of psoas disease there lesion of the spine. I have repeatedly met with is no deviation in the natural situation of the these complications, which have greatly aggra- trochanter, and no difference in the length of vated the sufferings of the patient. If, du- both limbs; in diseased hip, on the contrary, ring its increase, the abscess breaks external- this is always the case. 3d. In psoitis and ly, or is opened so as to admit the air, pus is lumbar abscess the patient cannot turn the discharged, at first without smell; but it sub-foot of the affected side outward without insequently becomes offensive, and the hectic symptoms more marked. The powers of the patient sink, and the stomach becomes irritable. In some cases the aperture either closes, and matter again collects, or it contracts, and remains fistulous for a considerable time. 6. III. DIAGNOSIS.-(a) During the formation of matter the patient suffers pain in the loins, and walking is painful. When the abscess is not large, the usual symptoms of suppuration may be absent, or so slight as to escape observation. Night or morning sweats, emaciation, and other hectic symptoms, however, generally appear or increase with the progress of the complaint. When the purulent collection bas increased so as to form an external tumour either in the groin or in the loins, or near the anus, a movement may be perceived in it upon coughing. When the matter has gravitated towards the thigh or anus, the tumour is lessened by the recumbent posture. If the patient has suffered continued pain in the loins for four, five, or six months; if he has difficulty in extending the thigh, especially when putting his legs together; if he feels pain and tightness in the groin, and increase of pain on attempting to exert the limb, or when the psoas muscle is either put on the stretch or exerted, then this disease should be suspected, even although no external tumour has yet appeared; but if such tumour is present, there can be little doubt of its nature. creasing the pain; in diseased hip the foot is generally turned outward. 4th. On taking a deep inspiration, on coughing, crying, and in the erect posture, the fluctuating swelling either in front of the thigh or on the nates increases, and exit of matter, if the abscess be open, is facilitated; but in abscess of the hip-joint neither phenomenon is observed. 9. IV. PROGNOSIS.-The prognosis of psoitis, especially when the inflammation has gone on to abscess, is extremely unfavourable. Professor COLLES states, that not one patient out of fifty recovers from it; and that, in the course of his practice, he has not known five cases in all recover. He never knew a case get well where a surgeon interfered at all with it. In my own practice, I know only of two recoveries. For these no surgical aid was required beyond the formation of an issue in the back or loins. When psoas abscess is complicated with tubercles in the lungs, or with paraplegia, or with phlebitis or neuritis, instances of such complications having occurred in my practice, the case is then hopeless. I may, however, add, that psoas abscess may become complicated with hip-disease, a case of this association-the latter supervening on the formerhaving been under my care; or hip-disease may give rise to psoas abscess, as shown by Dr. M'DOWELL. 10. V. TREATMENT.-This disease usually appears so insidiously, and advances so slowly, 7. (b) Psoas abscess, when protruding under that it has proceeded in most cases beyond the POUPART'S ligament, may, as Mr. SOUTH ob-influence of treatment before medical aid is reserves, be mistaken for femoral hernia, especially as it dilates on coughing, and partly subsides when the patient lies down. But it is generally quired. When it is recognised at an early stage, and especially when the lesions of the vertebræ are not far advanced, or the inflamma tion consequent upon them has not given rise | LIUS remarks, that the absorption of the matter to much suppuration, then reasonable hopes may be procured in some cases, although raremay be entertained from the use of appropriately, by issues or perpetual blisters in the loins, means. If the powers of the patient be not re- and by general treatment, which promotes the duced, if there be no sign of anæmia, or of im- abdominal functions and the patient's strength. paired vascular action and tone, the application | DUPUYTREN observes, that these abscesses may of leeches, or cupping in the vicinity of the ver- remain for years, and the pus either be absorbtebral lesion, according to the state of the case, ed, no trace of them remaining, or, after a time, should be prescribed, and aided by stomachic they may increase, the skin covering them beaperients and cooling diaphoretics, with suitable coming inflamed and giving way. In rare inattention to diet and perfect quietude. After stances, the pus may drain away and not be sufficient local depletion, I have generally di- reproduced, or, after a longer or shorter time, rected either of the following embrocations to it may be converted into adipocerous matter. be applied to the back or loins by means of flan- These, however, are favourable terminations nel, and renewed once in the twenty-four hours of rare occurrence. Much more frequently the if it be found to agree; the sensations of the abscess goes on increasing, either until it inpatient, the state of the pulse, and a careful flames and bursts the skin at the most promobservation of all the symptoms guiding the inent point, or until it opens into one of the physician : hollow viscera, or until the distressing effects produced by it, as already adverted to, create a necessity for opening it. No. 325. R. Linimenti camphora comp.; Linimenti terebinthine; Linim. saponis cum opio, aa, j.; Olei cajuputi, 31. 11. Fiat embrocatio. No. 326. R. Linimenti terebinthine; Linimenti camphore comp., ãã, 3jss.; Olei olivæ, 3iij.; Olei cajuputi, 3j. m. Fiat embrocatio. 14. Mr. SOUTH observes, that issues are most important aids in the treatment of psoas ab. scess, either before or after it has opened of itself or been punctured, and that no circumstance should prevent a recourse to them. He advises the issue to be made on the side of the spine opposite to that where the abscess is seat 11. If these embrocations fail, after local depletions and other constitutional or suitable means, to arrest the progress of the disease, open blisters in the vicinity of the part or issues ought to be ordered, and kept freely dis-ed. If presenting in one of the lumbar regions, charging; while an alterative and restorative influence should be exerted on the constitution by a course either of the iodide of iron with sarsaparilla, or of the iodide of potassium and liquor potassæ, with compound tincture of bark and fluid extract of sarsa; or of the bichloride of mercury, in either the compound tincture or decoction of cinchona. I have alternated short courses of these, varying them according to circumstances, during the operation of the applications, issues, &c., advised to be applied near the diseased vertebræ, and often with marked benefit. I have prescribed iodine for this disease since 1822. 12. Several surgical writers, even ABERNETHY, COOPER, DUPUYTREN, LAWRENCE, PEARSON, CHELIUS, SOUTH, and others, have directed their attention and their treatment chiefly to the consecutive abscess. But if the abscess be not large, if it be not complicated with paraplegia, or if it occasion no distressing symptoms, as it sometimes does, by its pressure on nervous, venous, or arterial trunks, or large branches, it should not be officiously interfered with; the external drains, &c., placed near the diseased vertebræ, the constitutional means prescribed above (§ 11), and such other aids as stomachic aperients, &c., as the peculiarities of the case may require, being the remedies most deserving of confidence. If these means succeed in even partially removing the spinal disease, the consecutive abscess, if not large, will either diminish or become absorbed, at least in some instances, as in two of those which have come under my care, and for which the above treatment, without opening the abscess, was pursued. In one of these cases the treatment sometimes consisted, during the intervals between courses of the above medicines (11), chiefly of full and regular doses of either morphia or opium, which also were occasionally given with these medicines. the issue should be made at the outer margin of the quadratus lumborum of the opposite side; but if there be abscess in both lumbar regions, issues ought to be placed above and below them. If the swelling appear at the top of the thigh, an issue may be made on the same side, or in both sides of the spine, but never over the spine, nor over the abscess itself, for very obvious reasons. The issue should be made the size of a sixpence, with caustic potash, and it will generally enlarge to that of a shilling one, or both, should be kept freely open and discharging, as just advised, while the constitutional and restorative powers ought to be promoted by the means recommended above. : 15. Much difference of opinion exists as to the propriety of opening psoas or lumbar abscess, or of waiting for the self-evacuation of it. My own observation leads me to state, that there are cases for which surgical interference is either unnecessary or injurious; while there are others for which it may be most beneficially employed, if not for a cure, at least for the alleviation of the sufferings of the patient, and prolongation of life. When required, the opening should be made, as advised by Mr. ABERNETHY, so as entirely to prevent the entrance of air through the aperture, otherwise inflammation of the sac, increased hectic, offensive discharge, and sinking of the powers of life will ensue. An opening thus carefully made, and subsequently managed as carefully, will often prevent those painful complications observed in the advanced course of the malady, and to which surgeons have not sufficiently adverted. The occasional inflammation and erosion of vessels adjoining the purulent collection, and the distressing symptoms which result, as well as the not unusual implication of a nervous trunk, or of some other important part, may be prevented, or even alleviated after their appearance, by opening the abscess be13. When the inflammation terminates in fore it has become so greatly distended as to suppuration, and an abscess is formed, CHE- | complicate the case and increase the sufferings |