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Few diseases have been considered more desperate than lumbar abscesses; and their remote situation, and an idea that they are universally connected with a carious state of the vertebræ, has hitherto preserved them from the interference of surgery. Mr. Abernethy's practice and observations have, however, convinced us, that they ought not to be placed on the list of incurables, and prove how far scientific investigation is capable of disarming the most formidable diseases. Lumbar abscesses are generally complicated with a carious state of the vertebræ, and the practice of Mr. Pott successfully proved, how far counter-irritation is capable of arresting this ulcerative process. Chronic abscesses are not in their nature dangerous, whether connected with diseased bones or otherwise, but become so from their magnitude, and the effects which, from this circumstance, they produce on the constitution; whence we clearly see, that the objects of surgery ought to be to prevent their increase or reduce their dimensions. In general they proceed in one tenor from bad to worse, till at length the swelling bursts, fever ensues, the patient becomes hectic and dies. The magnitude of the tumour is the cause of its bursting, and hence, in the cure of all chronic abscesses, the indications are to prevent their increase, and subsequently to promote their dispersion. Counter-irritation and an attention to the general health will often effect this, and leave the cure of the diseased bones a work of subsequent importance.
But the abscess will sometimes continue to increase, the integuments become irritated from distension, and the swelling is proceeding to burst. The question then is, whether we should allow it to open spontaneously or treat it like phlegmonous abscesses. If inflammation supervene and it burst spontaneously, or a permanent opening be made into it, the most horrible effects supervene. A violent degree of irritation takes place in the sac; the constitution sympathizes with such an extensive inflammation; the patient is feverish and generally hectic. This constitutional derangement has generally been imputed to the admission of air into the cavity of the abscess,
or the absorption of pus from it. Neither of these explanations however, appear probable; for the contact of air in an emphysematous state of the cellular membrane, or when blown into the cavities, does not cause inflammation, nor does it on ulcers in a state of disease; nor does the absorption of pus from the surfaces of ulcers and abscesses produce any constitutional derangement. The inflammation seems to be propagated from the opening throughout the immense surface of the cyst, and the constitutional derangement and fever are sympathetic with this great extent of irritation. The object therefore is to evacuate the abscess in such a manner as shall not excite inflammation. This Mr. Abernethy effects by a small puncture through a sound part of the integuments, and immediately closing the wound by the adhesive inflammation. Inflammation rarely follows this operation; the sac contracts and the subsequent collection is evacuated before the distension has brought the cyst to its former magnitude; and by a repetition: of this process it is reduced to an extent which allows no dread of inflammation from a permanent opening. This practice is applicable to chronic abscesses in all situations where the extent of the cyst would lead us to dread the effects of its inflammation.
It is this treatment, which Mr. Abernethy ventured to recommend in cases of spina bifida, and which Mr. Okes so prematurely reprobated. Unfortunately for Mr. Okes, at the very time he was writing his book, and in his closet had so decidedly determined the impossibility of the practice, Mr. Astley Cooper, in his great field of experience, had actually proved its excellence in many instances. This gentleman has already committed to the press the accounts of several cases in which this treatment has completely succeeded; and the death of the patient from another cause, in one instance, enabled him to determine that contractability of the membrane, which Mr. Okes had denied. These cases furnish a most complete refutation of Mr. Okes's speculations, and prove how Q
little dependance should be placed on reasoning which is not deduced from absolute experiment.
The volume before us concludes the series of Mr. Abernethy's observations; constituting, in our opinion, the most valuable addition which has been made to surgery since the time of Mr. Hunter. Our author has pointed out a new source of local diseases; he has discriminated the innumerable affections which emulate the appearance of syphilis; he has boldly advanced the operation of aneurism to an extent, the possibility of which has been denied by many experienced surgeons; and in the present volume he has commenced the cultivation of an immense tract of disease which hitherto knew but one history and one treatment. His book is a simple narration of most important facts, and his deductions from them may be regarded as axioms in the practice of surgery. The progress which his doctrines are daily making is the best earnest of their importance, and the success of his operations is the best answer to those who have denied their possibility. If we have ventured in a few instances to dissent from him, we have only availed ourselves of his readiness “ to encounter these risks, when we had it in view to bring a difficult and interesting subject fairly before the public.” We are confident that Mr. Abernethy would prefer a free investigation of his opinions, to an obsequious vassalage to his authority. “ To exert reason is not to revolt against authority; reason and authority do not move on the same parallel.”
Copy of a Letter from BENJAMIN SILLIMAN, Professor of Che. mistry at Yale College, to DAVID MELVILLE, Patentee of the Improved Gas Apparatus.
New Haven, August 18th, 1814
Mr. David Melville,
Your favour of the 8th instant is before me, and I beg you to accept my thanks for the enclosed engraving of your apparatus for the gas lights. The print is very handsome, and does good justice to your apparatus. When you were so obliging as to show it to me, during my visit at Newport, last summer, I was agreeably surprised to see an apparatus so perfect, contrived and constructed in this country, where the subject of the gas lights is less generally understood than in Europe. I think your apparatus simple and effectual, and well adapted to the purposes of manufacturing establishments, and the flames which you shewed me were brilliant, and burned without smoke or smell.
Nothing, but a general knowledge of the gas lights, is ne cessary to introduce them into the large manufacturing esta blishments, which are now becoming so numerous in our country. They have the strongest recommendation which can address itself to practical men; viz. economy. Those who feel particularly interested to know the details of the subject, may find all the information which they can reasonably desire, in very elaborate and minute reports, drawn up from actual experiments, made on a very great scale, in one of the largest manufactories in England, by Mr. Murdock; and in various papers, by Mr. Cook, and others, for which reference may be had to Nicholson's Journal, and other periodical works on science and the arts. It will be found, by referring to these, and other similar sources of information, that the saving pro
duced by the gas lights as a substitute for oil and tallow, is very great, and in large establishments amounts to a heavy sum. It is probable that circumstances in this country might produce some variation in the result, the degree of which experiment alone can determine. The gas lights are probably less adapted to private families than to public establishments, because, the care and skill which are requisite, are more than can be reasonably expected among common domestics. But, in large manufactories, the business of preparing the gas and of attending on the lights, will of course be assigned to a particular person, who, with a common share of ingenuity, will soon acquire the habit of doing this, as he would any other thing.
Economy is not all which recommends the gas lights; for, were they ever so cheap, if they did not, in a good degree, answer the desired purpose of affording a good light, no one would adopt them. The light from the combustion of the gas from fossil coal, when the coal is of a good quality, is remarkably brilliant and beautiful. I saw a large apothecary's shop in London, lighted with the gas from coal, and as the thing was then (1805) by no means so common in London, as at present, it drew a great concourse of people, every night, around the shop, and thus brought it into general notice. The proprietor of the shop was so civil as to shew me his apparatus, which was arranged in a cellar, beneath the room in which the lights were exhibited; and although the apparatus was a good one, I think it was inferior in several respects to yours. There was, however, one circumstance which struck me as particularly judicious, although I cannot say how generally it is adopted in other establishments of this kind; I allude to the placing of quick lime in the water of the apparatus intended to wash the gas; as the carbonic acid gas is the most troublesome foreign body which is commonly found mixed with the inflammable gas, the lime performs au important service, by removing it more rapidly than the water alone would do, or after it is saturated with it. I have tried many experiments on