224 ON RECENT IMPROVEMENTS IN THE 



the beautiful sight is witnessed of cessation of suppuration from the moment 

 that the original pus is evacuated, the serous discharge diminishing constantly 

 till the abscess cavity is closed. 



If antiseptic treatment had done nothing more than create such a revolution 

 in the treatment of abscess and throw such light upon its pathology, it would 

 have well deserved the gratitude of the surgeon. 



But in order that such results may be obtained, it is necessary that both 

 the above conditions be complied with — viz. a perfectly free outlet for discharge, 

 and thoroughly efficient antiseptic management from first to last. If the former 

 condition be not fulfilled, inflammatory suppuration from tension will occur ; 

 or if the accumulation of fluid be only to a very slight extent, increase or per- 

 sistence of serous oozing will be the result. And if the latter essential fail to 

 be maintained — as, for example, through inefficiency of the retaining bandage, 

 allowing the dressing to become loose or displaced, or through the antiseptic 

 treatment being given up too early, before the sinus has completely closed — 

 septic suppuration will take place, with its various consequences, such as free 

 incisions and counter-openings, or, in vertebral or articular disease, disaster 

 varying according to the circumstances of the case. 



A sponge wrung out of a strong watery solution of carbolic acid (i to 20) 

 forms a valuable aid to the drainage-tube in preventing, during the first twenty- 

 four hours, the accumulation of blood in wounds having a considerable cavity, 

 such as those left after the removal of tumours.^ The wound having been 

 stitched and the drainage-tube (or tubes) inserted, a strip of oiled silk protective 

 is laid along the line of incision to keep it moist, and so prevent the sponge 

 from adhering. A soft sponge, large enough to cover the entire cavity of the 

 wound and purified as aforesaid, is then applied, and over it a gauze dressing 

 sufficiently extensive to reach several inches beyond the sponge in every direction. 

 The whole is retained in position by a pretty firm bandage, so as to bring into 

 play the elasticity of the sponge, which keeps the surfaces of the wound in 

 apposition, and, while checking sanguineous effusion, compels that which does 

 occur to escape by the drainage-tube, when it is at once sucked up b}^ the sponge 

 as it oozes from beneath the protective. 



If any one desires proof of the potency of a strong watery solution of carbolic 

 acid to deprive septic ferments of their energy, he cannot do better than consider 

 the results of this mode of dressing. The same sponges are used over and over 

 again till they wear out, and for hospital purposes they are kept always steeping 



^ The sponge had long been a favourite apphcation of Mr. Syme's under such circumstances, and 

 he was the first to use it antiseptically. The case was one of very large parotid tumour, in a woman 

 advanced in years ; and the dressing employed was a large sponge squeezed out of carbohc oil, which 

 answered its purpose admirably. 



