140 OPERATION FOR HEPATIC ABSCESS. 



When the abscess opens into the abdominal cavity, 

 although death is almost inevitable, yet much may be 

 done by absolute rest in the recumbent posture ; warm 

 compresses or cataplasms, and the administration of 

 Ars., Merc. Corr., Bell. Bryon., with an occasional dose of 

 Aeon, or Verat. Vir., according to the prominence of 

 the symptoms. When the abscess takes an outward 

 direction there should be no delay in making an artificial 

 opening, as much danger to neighbouring structures may 

 be thus avoided. The most simple and satisfactory 

 operation is that recommended by Begin : he places the 

 patient on his back, with the upper part of the body 

 bent forward, and the thighs flexed on the abdomen ; after 

 having carefully ascertained the outline of the abscess, 

 which the thinning of the walls and fluctuation enable 

 us to do, an incision three inches long is made through 

 the skin, cellular, adipose, muscular, and aponeurotic 

 tissues. The peritoneum is then opened like hernia 

 by being slit up on a grooved director to the extent of 

 the first incision. The wound is now dressed with lint 

 or cotton wool. After three or four days the dressing is 

 removed, and the liver is found to have contracted linn 

 adhesions to the margins of the wound, so that the abscess 

 may be punctured without the slightest risk. This 

 operation is simple, safe, successful, and easily performed. 

 Graves, of Dublin, adopts the same plan. lUidd found 

 it unsuccessful in two cases operated on, on board the 

 Dreadnought. Indian surgeons thrust up a long exploring 

 needle into the liver when the presence of an abscess is 

 suspected. Cures are uncertain. 



R^camier and other surgeons apply to the most pro- 

 minent part of the swelling caustic potash, so as to 



