the head turns usually to the opposite side from which the pus flows or opposite direction from the curve of the spine. This is necessary to maintain the centre of gravity and keep the head erect. The older surgeons and physicians have given specific names to these abscesses, naming them according to the part affected :-

I. Cervical. Abscess.--Where the disease affects the cervical vertebræ. II. Dorsal Abscess. Where the dorsal vertebræ are the seat of the disease.

III. Lumbar Abscess.-Where the lumbar vertebræ become absorbed and point on the back.

IV. Psoas Abscess.-Where the dorsal or lumbar vertebræ inflame and the pus trickles down the psoas muscles and points in the groins.

V. Morbus Coxarius.--When the haunch bones become diseased and form pus.

These abscesses are usually slow in formation, with dull and throbbing pain, sometimes for weeks. months, and even years before there is any appearance of pus or abscess to be seen or felt.

SYMPTOMS.

Cervical abscess is generally known by its forming below the ears and between the the chest a soft tumor with the head turned to that side if near the ear, and to the opposite if near the chest: provided the erosion is on either side.

If the body anteriorly is decayed, there will be a protrusion backwards of the space in which the vertebræ are absorbed, and a tumor in front and under or near the æsophegus gradually appears. The appetite is generally depraved and the respiration is seriously affected. Patient is, or soon becomes, ænemic, and will lie down or rest the head against some support or hold it between his hauds.

In dorsal and lumbar abscess the patient first complains of gastralgia.* Dr. C. T. Taylor says this is pathognomonic of the disease and is attended with all others as general debility, loss of appetite, listlessness, disposition to lie down, to walk with a crutch, and never to run, jump, ride in a trot or in a rough carriage. Patient has flushes of head and night-sweats, generally a piebald or mottled skin, if the patient is over twenty, especially so in old patients.

These symptoms apply equally to psoas abscess.

Morbus coxarius is known by a stiffness of the hip-joint and a pain in

*See Drs. Taylor and Lee on Curvature of the Spine and Infantile Paralysis.

4

the head of femer. This pain is often very severe, simulating synovitis of the joints and rheumatismus acute. The leg at first is curved and turned in or out, as the head of the femer is eroded to the right or left, but turned always to the side which is affected, after the abscess forms and the pus is discharged the leg shortens and contracts to an immovable position and there forms true auclylosis.

CAUSES.

As before stated, contusions are usually the prime cause, and, in most cases, the only cause. A tubercular diathesis is the next most remote cause, and it is, in all cases, a great predisposing cause.

Bad and innutritious food, confined atmosphere, want of sun and light, all have a powerful predisposing effect. Lifting and carrying heavy weights, falls on the ice or pavements, falls down the stairs, out of trees, &c., &c.

Cold climates seem to predispose also to these affections, as they are seldom seen in this latitude (29°.15); whether this is to the inclosure during long winters, or the want of sun light, or breathing bad and infected air, I am unable to state, but believe these combine to make the disease more frequent in northern than in southern latitudes.

PATHOGENE.

There is a remarkable resemblance in the lesion, whether it occurs in any of these places. There is loss of ossious tissue by absorption and suppuration of pure white or cream-like pus. This pus becomes incysted, or has its pyogenic membrane, which becomes pure mucus when opened to the air and secretes mucus and pus. The sac enlarges by absorption and assumes different positions and shapes according to the tissues that surround the eroded part.

When pus is once formed there does not appear any power in the constitution to produce a spoutaneous cure, which is the case in most other inflammations if not too severe to prevent healthy respiration and innervation in the general system. This is, no doubt, owing to the constant weight and pressure on the part which, without mechanical means, must continue as long as the body is erect or any of the muscles surrounding the part contract, or as long as there is motion of one bony corroded part grating over another, which is produced whenever there is motion without extention of the muscles.

This teaches us and leads us to inquire what are our best modes modes of

TREATMENT.

The first thing to be done, in all and every case, is to relieve pressure and separate the joints, and give free and easy motion or, what is better, entire rest. This must be done by mechanical means alone.

For the cervical vertebræ we recommend as the best Dr. Benj. Lee's apparatus; but, before applying this, we must make out the exact position of the lesion and the direction of the curve of the spine and endeavor to put it erect.

This is easily done by placing the patient as Dr. Bauer directs, in the erect position, and dropping a plumb-line from the top of his head to the centre of the feet for lateral curvature; for frontal or dorsal, drop the line from the top of the shoulders to the outer maleolus. This will readily indicate the line or centre of gravity, and the side to which the spine curves is to be pressed upon, and the side from which the curve forms a concave surface should be elevated and supported, bringing (in all cases) the angles of the vertebræ to their proper curves, which. in perfect health, is on the spinous process, from the head to the coxyx, and from the parietal suture at the top of the head through the centre of the shoulders to the ankle.

For remedies of cases of the dorsal or lumbar vertebræ we recommend the apparatus demonstrated in Dr. C. F. Taylor's work on Infantile Paralysis; and, in morbus coxarius, Prof. L. A. Sayre's movable joint splint.

Having applied our mechanical means well, so as to remove all pressure, prevent the sudden or severe contraction of the muscles, we must resort to hygenic means more than to physic.

Keep our patient as much as possible in the open air, exposed to light and wind., Feed him with nutritious food; get the blood rich and keep it so.

Exercise all the muscles except those involved, but not to fatigue the patient. Abstain from the use of tobacco, or any depressing anodynė ; eschew any and everything that disagrees with the stomach; take food well salted and use universal diets as eggs and milk.

Medicines, as a general thing, are never reliable; but all those recom- mended for debility or the tuberculous diathesis are good and useful. Iodide of potash and sarsaparilla, bromide of potash, quinine, citrate of iron, tincture cinchonæ, turpentine emulsions, &c., &c.; small blisters over the seat of pain occasionally.

The most difficult part of the treatment is to deside whether and when should we open these abscesses.

Dr. Lee tells us the pus will be absorbed if the pressure be removed and the patient will gradual convalesce.

In this I will agree; but when it once forms it becomes quite a tumor can this be be removed by absorption? I believe not-I have never seen a case that did.

Is there any danger in opening them? I think not; it is sometimes a means of cure.

All surgeons and physicians now condemn moxas, setons and the actural cautery that were once so popular. Even blisters, such as we

have recommended, are thought to be of doubtful utility.

For the further illustration of this subject, we have reported the following cases :—

Mr. T. M. Thomas, of Columbia, Brazoria co., Texas, reported in Nashxille Medical Record, Nov., 1859, from which we copy. Mr. Thomas it still living and following his trade-waggon-maker:

PSOAS ABSCESS.

CASE 1.-Mr. T. M. Thomas-ætat 60--Lymphatic temperament. In November, 1857, Dr. Anger requested me to visit the above-named patient with him. We found him in the following condition :----He had a soft, pulpy tumor just below Poupart's ligament, on the right side. The skin was red and tender over the tumor. There was a distinct pulsation from coughing; the tumor could not be lessened by pressure to any great extent. Dr. Anger was in doubt as to whether it was psoas abscess or strangulated omentum hernia. He had been using warm and stimulating lotions, laudanum, iodine, &c., but to no effect. Mr. T. says he was hurt about two months ago by lifting a piece of house or rail timber, since which time he has had a dull, dead pain in the lumbar region and down the psoas muscles. From all this we inferred it was psoas abscess, but, to be on the safe side, we determined to wait two more days, and during that time to apply anodyne lotions. So the Doctor's prescription was continued with doses of citrate of quinine and iron as a tonic. On the third day the Doctor made a valvular opening with a trocar. Pulling the skin down well, and after passing the point of the trocar through the skin, it was slipped up and the point passed into the abscess. It discharged a considerable quantity of pure white pus. A strip of adhesive plaster was put over the orifice. We gave him internally-

Iodide of potash, 1 oz.

Simple syrup of sars., 1 qt.

Took a tablespoonful three times a day--two hours before each meal. On our visit three days afterwards the abscess had opened above where we had punctured it, and was discharging pus. It was dressed with simple cerate, and the potash and quinine continued as above for one week, then we gave the following:

Iron, by hydrogen, 1 oz.

Simple syrup of sars., 1 qt.

Tablespoonful three times a day. Ten grains of citrate of quinine and fron every other day for eight days. Under this treatment he entirely recovered and is now well and hearty.

CASE 2.-Dr. Rubin Smith, of Sandy Point. The 10th of Dec., 1861,

we received the following letter from Dr. Smith. He is the nephew of Dr. W. R. Smith, of this city:—

DR. G. DOWELL :

DECEMBER 3, 1861.

Dear Sir, I have a large tumor seated on my back in the region of the right scapula. It is painless, and has been forming about six or eight weeks. At present there are few, if any adhesions; the skin is not implicated, and the tumor is still movable, but, I fear, if it remains longer adhesions will take place and render its removal more difficult. If you can make it convenient I would like you to come up and operate I prefer being at home so that I can have better attention than if I was anywhere else. Please let me hear from you immediately. If you prefer coming up on the cars, I can send for you at Sandy Point any day that you will name. I would like to have it done as soon as pos

sible.

As soon as possible I visited Dr. Smith, at his father's, on Oyster Creek, and found the tumor as he has described, lying upon the scapula, divided by the spine into two parts---apparent lobes. He had a curvature of the spine, and had been using shoulder-braces to straighten him up, and he had gotten better. He thought the pressure on the scapula was the cause of the tumors, and we thought it was there before and was only indicated by the pressure.

It was movable, and I believed it to be a fatty tumor in two cysts, so we concluded to excise it. On the 20th of December, in the presence of and assisted by Drs. S. A. Towsey, D. W. Oliver and - -Tompkins,

then of Sandy Point, all of whom had seen him frequently and counselled with him to have it taken out. We were, as I now remember, all of the same opinion; so we put him under chloroform, and I began an ovoid incision around the tumor, which was nearly as large as the fist. In cutting under it as I thought, I cut one of its points and out poured the pus. Put him upon quinine and iron, and bandaged the part tight as possible. Alternated with iodide of potash and sarsaparilla. Gave him porter, wine, and brandy, but it continued to suppurate, and I took him to my room in Columbia. Injected a weak solution of tinct. of iodine into the sac, and he coughed up blood. Repeated this several times but it done no good and he left worse than he came. Went to Sour Lake, in Hardin county, and was under the care of his uncle until he died, which took place in the fall, about 130 days after the operation.

REMARKS.

This is a remarkable case, showing that pus may find its way along the course of the levati anguli muscles to the back of the scapula and assume the appearance of a fatty tumor which was the case in this