34 ON A NEW METHOD OF TREATING 



by the nurse or a friend of the patient ; or a larger quantity may be made at 

 once, and kept in a tin canister. The dressing is changed, as a general rule, 

 once in twenty-four hours ; but if the abscess be a very large one, it is prudent 

 to see the patient twelve hours after it has been opened, when, if the towel 

 should be much stained with discharge, the dressing should be changed, to 

 avoid subjecting its antiseptic virtues to too severe a test. But after the first 

 twenty-four hours, a single daily dressing is sufficient. The changing of the 

 dressing must be methodically done, as follows : A second similar piece of tin 

 having been spread with the putty, a piece of rag is dipped in the oily solution, 

 and placed on the incision the moment the first tin is removed. This guards 

 against the possibility of mischief occurring during the cleansing of the skin 

 with a dry cloth and pressing out any discharge which may exist in the cavity. 

 If a plug of lint was introduced when the abscess was opened, it is removed 

 under cover of the antiseptic rag, which is taken off at the moment when the 

 new tin is to be applied. The same process is continued daily till the sinus 

 closes. 



The results of this treatment are such as correct pathological knowledge 

 might have enabled us to predict. The pyogenic membrane has no innate 

 disposition to form pus, but does so only because it is subjected to some preter- 

 natural stimulus. In an ordinary abscess, whether acute or chronic, the original 

 cause that led to suppuration is no longer in operation, and the stimulus that 

 determines the continued pus-formation is derived from the presence of the pus 

 pent up in the interior. When an abscess is opened in the ordinary way this 

 cause of stimulation is removed, but in its place is substituted the potent stimulus 

 of decomposition. If, however, the abscess be opened antiseptically, the pyo- 

 genic membrane, freed from the operation of the previous stimulus without the 

 substitution of a new one, ought, according to theory, to cease to suppurate, 

 while the patient should be relieved from any local or general disturbance caused 

 by the abscess, without the risk of irritative fever or hectic. 



Such, accordingly, is the fact. Abscesses of large size have, after the 

 original contents have been evacuated, furnished no further pus whatever, the 

 discharge being merely serum, which in a few days has amounted only to a few 

 drops in the twenty-four hours. Whether the opening be dependent or not 

 is a matter of perfect indifference, the small amount of unirritating fluid being 

 all evacuated spontaneously by the rapidly contracting pyogenic membrane. 

 At the same time, we reckon with perfect certainty on the absence of all 

 constitutional disturbance. 



As an illustration, I may mention the last case which has come under my 

 care. It is that of a young woman, twenty-five years old, with psoas abscess, 



