2i6 ON RECENT IMPROVEMENTS IN THE 



The oil, penetrating among the folds of the skin, is more efficient for this situation 

 than the gauze would be, even were it frequently changed. After two or three 

 da^'s have passed, the strength of the oil may be reduced to i to 20, if the 

 stronger proportion causes irritation. I have treated several cases in this way 

 both in hospital and in private practice, and in every instance the occurrence 

 of fistula has been avoided, although in some of them it was ascertained, by 

 digital examination of the rectum before opening the abscess, that pus was 

 present in the submucous tissue — a state of things which, I believe, inevitably 

 leads to fistula if the abscess is treated in the ordinary way. Of course 

 scrupulous care on the part of the patient is essential to success, but this 

 I have not found wanting, even in hospital cases, when it is clearly explained 

 that fistula will be prevented by the requisite pains. 



It is an interesting fact, pathologically, that the progress has been equally 

 satisfactory when the pus has been fetid on evacuation as when it was odourless, 

 the discharge being a mere serous oozing after the escape of the original contents. 

 This seems to imply that the cause of the fetor was not any organic (bacteric) 

 ferment, but a peculiarity in the action of the part. For had septic organisms 

 been present before the abscess was opened, they would have continued to pro- 

 pagate in it in spite of the antiseptic treatment ; and the result would have been 

 the same as under poultice or water dressing, or, what comes to the same thing, 

 under an antiseptic dressing carelessly employed. For it is hardly needful to point 

 out that neither the spray nor the carbolic oil applied external^ , nor the oiled lint 

 inserted in the outlet to serve as a drain, could correct putrefactive fermentation 

 once established in the abscess cavity. Here, as in the antiseptic treatment 

 generally, the means used are calculated to prevent, not to correct, putrefaction. 



In the case of abscess beside the rectum a bit of lint soaked with carbolic 

 oil is used for a drain, simply because in this situation it is not easy to keep 

 in position a caoutchouc drainage-tube, which, under ordinary circumstances, 

 is greatly to be preferred, since it does not at all obstruct the flow of discharge, 

 and may be carried to an}' depth that is desired, and can be removed and reintro- 

 duced without difficulty. Hence a drainage-tube of comparatively small size 

 introduced through a mere puncture in the skin, or through a small interval 

 between stitches, is more efficient than a free incision or a widely gaping wound 

 mthout the use of a tube. The tubes should vary in size in proportion to the 

 quantity of discharge anticipated, from the thickness of a crow-quill to that 

 of the little finger, and the holes in them should have a diameter about half 

 that of the tube. The outer end of the tube should be on a level with the skin, 

 and it is conveniently maintained in this position by means of two pieces of 

 silk passed with a needle through two opposite points of the edge of the tube, 



