208 AROUND THE WORLD VIA INDIA. 



being the most likely direction in which to strike pus. 

 It is gradually withdrawn if no pus is found, and rein- 

 troduced in another direction. Five or six different 

 parts of the liver are thus carefully explored before the 

 ease is sent, back with a negative result." The explora- 

 tion is made under an anesthetic, and if pus is found 

 the operation is performed at once. After resection of 

 about two inches of the ninth or tenth rib in the axil- 

 lary line the liver is exposed by an incision. If adhe- 

 sions are present the liver is incised at once; if there 

 arc no adhesions a strip of gauze is carefully packed 

 all around the proposed line of the visceral incision. 

 Sutures are never used, as they tend rather to favor 

 than prevent the escape of pus into the serous cavities. 

 With a small scalpel the capsule of the liver is incised. 

 If the abscess is deeply situated a sinus forceps is pushed 

 through the liver substance into the abscess, followed 

 by the index finger, and the needle is then withdrawn 

 and one or two Keith's glass drains inserted. After 

 evacuation of the pus one or two large fenestrated rub- 

 ber drains are substituted for the glass drains and a 

 large aseptic absorbent dressing applied. Washing out 

 the cavity with antiseptic solution- is abstained from, 

 although the operator has seen good results from the 

 use of a solution of quinin. 1 in GO to 1 in 80, as advised 

 by Capt. L. Sogers, I.M.S. 



The nursing in the Madras General Hospital is in 

 charge of 38 trained female nurses. 51 male ward at- 

 tendants and 21 female ward attendants. Twelve fe- 

 male nurses resigned during the year and gave their 

 reasons for this step as follows: Left to be married, 6; 

 left to train as midwife, 1; retired on pension. 2: re- 

 tired mi account of ill health. 2; retired for private 

 reasons, 1. 



The amount of available clinical material of this 

 hospital is something enormous. During the last year 

 the institution eared for 60,842 out-patients and 7,177 

 in-patients. The total number of deaths that occurred 



