226 ROGERS. 



showed scars of recently healed ulcers, together with a few depressed slits 

 of those almost healed. Another remarkable case was one of Major 

 O'Kinealy's, in which no less than 3 liters (6 pints) of pus were aspirated 

 from the liver of an Indian patient. This pus was found to be sterile as 

 regards bacteria. Five days later 1,064 cubic centimeters (36 ounces) 

 were withdrawn, and 2.66 grams (40 grains) of the soluble bihydrochlo- 

 ride of quinine injected. The patient improved steadily and put on 

 8£ kilograms (18 £ pounds) weight in five weeks, recovering completely. 

 Such cases speak for themselves. 



In carrying out this method, the skin at the seat of puncture must 

 be thoroughly sterilized to prevent bacteria being carried into the abscess 

 cavity. The T tube of the exhaust bottle should have a large caliber to 

 allow thick pus to pass, the cavity being emptied as far as possible, and 

 some of the pus put in a sterile test tube for bacteriological examination. 

 A previously boiled solution of the bihydrocholoride of quinine, 2 grams 

 to 100 cubic centimeters (10 grains to the ounce) is next injected into 

 the cavity through the canula, which is then withdrawn and collodion 

 applied externally. If only a few cubic centimeters (ounces) of pus have 

 been found, 60 cubic centimeters (2 ounces) of the quinine solution will 

 suffice, but if a pint or more of pus has been removed, 120 cubic centi- 

 meters (4 ounces) should be injected. In some cases the temperature at 

 once falls and all the symptoms rapidly subside, but more frequently the 

 process has to be repeated after a week, while third and fourth aspirations 

 are sometimes required in large abscesses. If a previously present leucocy- 

 tosis completely subsides, little or no pus is usually obtained at a second 

 operation, but the continued presence of leucocytosis is an indication for 

 further aspirations, quinine being injected each time. In Major Spencer's 

 cases the hydrobromide of quinine was used successfully. In the rare cases 

 in which the aspirated pus is found to be swarming with bacteria the abscess 

 must be opened. Further experience is required to lay down the exact 

 indications for this method, but the success already obtained is sufficient 

 to make it advisable to give the patient the benefit of a trial of this simple 

 and safe mode of treatment in all cases in which there is no definite 

 contraindication before resorting to the much more serious open operation. 



STERILE SYPHON DRAINAGE OF LIVER ABSCESS. 



The practical impossibility of maintaining sterility in the Tropics 

 after the open operation for liver abscess, taken with the occasional 

 failure of raj plan of aspiration and quinine injecton, suggested to me 

 the advisability of devising a method of sterile drainage, combined with 

 quinine irrigations. For this purpose I got Messrs. Down Brothers, of 

 London, to make for me the flexible sheathed trocar. 9 It is made in 

 various sizes and can be used as an aspiration trocar, the abscess being 

 first located with the ordinary small-sized trocar if its position is not 



'Hid. (1908), 2, 1246. 



