Anthrax or carbuncle, another species of phleg mon, is merely an aggravated or more violent spe cies of furunculus, and is an extensive, flat, hard tumour, of a dark purple colour, darker in the cen tre than at the circumference, and feeling very deeply seated. It commonly occurs on the back between the shoulders, and begins with great heat and acute pain, a diffused tumefaction, followed early by a small itching pimple, which soon be comes a vesicle or blister, and bursts, discharging a thin brown or bloody sanies, followed by the ap pearance of a yellow coloured slough. Sometimes several pimples are produced by the patient scratch ing the surface, which becomes intolerably itchy, while on other occasions several vesicles occur, which spontaneously burst, and discharge the same bloody sallies. When the disease is left to itself, these apertures slowly ulcerate, and run into one another, exposing to view an extensive slough, which, when thrown oft leaves a large ulcerous cavity, discharging bloody sallies. Whenever a carbuncle begins, it should be freely leeched or scarified, large anodyne poultices or fomentations applied, and as soon as suppuration takes place, it ought to be divided by a crucial incision, and the poultices then should have turpentine, resinous ointment, or camphorated oil mixed with them, and continued until the slough is discharged, when it should be treated with charpie, moistened with turpentine or other stimulants, as it is very indo lent, and removing portions of it from time to time as they become loose.
Chronic inflammation is that inflammatory action which continues for a long period, so slow, mild and passive, as sometimes to be imperceptible, and considered by some authors as not to exist on many occasions. The most palpable example is that which follows an acute attack of inflammation of the eye, this organ continuing for months and even years, red, fretful, and weak, but not painful, hot, and fiery; all acute inflammatory attacks are liable to become chronic; but there is a chronic state of inflammation which begins a priori, as, for exam ple, that which precedes lumbar and other chronic abscesses, and also the formation of tumours. In superficial chronic abscess, there is occasionally tumefaction, which is circumscribed and hard, but attended with as little pain as in the deep seated abscess. In both there is commonly constitutional derangement, and they generally occur in a feeble frame of the scrofulous diathesis. In the progress of this disease the local symptoms of in flammation become more manifest, and still more so in the latter stages. This species of inflamma tion generally attacks serous and mucous surfaces, although every structure may become the seat of it. Bursa mucosx, as that under the deltoid or glutx us maximus muscles arc very often attacked, and so also is the synovial membrane of the knee-joint.
The treatment of chronic inflammation, when it attacks an exposed surface as the eye, or accom panies an ulcer, is by stimulant lotions and oint ments. The diet should be chiefly farinaceous,
bowels attended to, the eyes kept from a bright light, and little or no exercise allowed; when it at tacks a mucous canal, as the urethra, by the same stimulant lotions still more cautiously used, and the same diet, with perfect rest in the horizontal posture. When it attacks a deep-seated structure, such as the bursa of the deltoid, the application of' leeches or the scarificator is necessary, the latter, however, deserves to be preferred, in consequence of the external irritation excited; these, together with low diet, gentle laxatives and perfect rest, may prevent suppuration; but they generally re quire to be followed by the moxa. In deep-seated chronic inflammation, the moxa appears to act by inducing counter-irritation or counter-inflammation, which removes the action of the inflamed vessels from the disease to itself, and also excites active absorption. On these grounds, the more quickly the ulceration produced by the moxa heals, so as to enable another to be applied, the better, and hence, small but deep eschars made by moxas are better than m issues ones. The practice, therefore, of keep g ssues open is now nearly obsolete.
Chronic abscess is the cyst or sac of matter re sulting from chronic inflammation, and occurs of ten in the abdominal muscles, particularly in the psoas magnus, and is then termed psoas or lumbar abscess. This species of abscess attacks likewise the ovarium, and indeed every kind of structure. It affects every age and constitution, but more fre quently early life, and the scrofulous habit, in con sequence of debility. We are seldom aware of the existence of chronic abscess until the matter has been actually secreted, when it ought to be evacua ted in the following manner. The skin is to he pulled upwards or aside, that it may act afterwards as a valve, when a small oblique aperture is to be made with the bistoury, and a silver probe inserted in the wound, and the matter evacuated, which is thin, serous, and mixed with curdly flakes, but sometimes purulent. The wound is to be imme diately closed with adhesive plaster, and healed by the first intention. During the treatment of chro nic abscess, the diet ought to be mild and nourish ing, the patient as much as possible in the open air, if dry and temperate, and if the scat of the dis ease will permit it; and he should take sulphate of quinine, or some of the preparations of iron or di luted sulphuric acid. When the psoas muscle is affected, he will require to he drawn in an easy hung carriage. Tepid and ultimately cold bathing, or sponging, with friction, are powerful auxiliaries. Whenever matter has again collected, however small in quantity, it ought to be discharged. The above treatment must vary considerably according to the seat of the disease.