THE BRITISH MEDICAL ASSOCIATION 187 



abscess was connected with diseased bone ; it may have been concomitant 

 with acute spinal symptoms, without being in connexion with the vertebrae.' 

 But the discharge of the bone with the pus makes us sure on this point. Well, 

 in that case the patient experienced immediate relief from his distressing 

 symptoms, without the occurrence of the slightest febrile disturbance ; and there 

 has been no discharge of pus since the evacuation of the original contents, though 

 up to the present time there has been still an oozing of serous fluid into the 

 gauze, which is changed once every four or five days. Four months, you may 

 say, is a long time for the treatment to have continued. Xo doubt it is so ; 

 but what is the alternative ? The alternative, as we all know, either if the 

 abscess be opened by free incision or allowed to open itself, is almost invariably 

 death, either after an acute course of irritative fever, which we should all wish 

 to prevent, or after a long period of protracted hectic, perhaps even more 

 distressing. Meanwhile, the serous discharge in this case has been steadily 

 diminishing ; and I have reason to believe, from previous experience, that we 

 shall ultimately obtain a cure. 



Among other cases of this kind, I may mention one as peculiarly instructive. 

 On the 20th of January, 1870, I opened a psoas abscess in a man twent\'-seven 

 years old, who from the age of eleven had had antero-posterior curvature in 

 the upper dorsal region of the spine. At length a psoas abscess made its appear- 

 ance, and, increasing slowly, extended far down into the thigh. I evacuated 

 between fifty and sixty ounces of thick pus, with lumps of curdy material, and 

 several small pieces of cancellated bone and numerous other osseous particles 

 came out in subsequent dressings. My friend Dr. Hector Cameron (the case 

 being a Glasgow one) undertook the after-management, continuing the antiseptic 

 dressing, and changing it, when the serous discharge became slight, every four 

 or five days — the lac-plaster being used ; and at length, on the 5th of February 

 last [1871] it was perfectly healed. Then, after giving the spine a few weeks' 

 more rest (for I believe, after such an abscess has completely healed, you ought 

 still to give the spine repose for a while, just as you would in a case of spinal 

 disease without abscess), that patient perfectly recovered, and is now walking 

 about, a healthy man. Here patience and perseverance, continued for more 

 than a year, were at length rewarded by success. 



In connexion with these cases of abscess, there is a curious circumstance 

 with respect to which I must put you on your guard ; that is. that sometimes 

 the discharge, serous though it is, soaking into the gauze, comes to stink in the 

 dressing, in the same sort of way as pus stinks when acted upon b\- the vulcanized 

 india-rubber, though with a different quality in the smell. Why this is, I do 

 not know. It seems that it is not the carbolic acid onl\- that occasions the 



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