AMCEBIO ABSCESS OF THE LIVER. 227 



accurately known. After the cavity is evacuated a piece of tubing of 

 large bore is connected with the end of the flexible sheath, and carried 

 into a bottle of antiseptic lotion under the bed, siphon drainage being 

 thus established. The sheath is so flexible that it can safely be left in 

 the cavity and used as a drainage tube. By means of a Y-shaped silver 

 tube connected with pressure tubing the aspirator can be applied daily 

 to the flexible sheath, and any thick pus which is not draining can thus 

 be withdrawn. Through the other limb of the Y tube, with a sterile 

 glass syringe, sterile quinine solution is injected daily, to kill the amoebae 

 in the wall of the abscess. The discharge rapidly lessens and the cavity 

 contracts. Thus, in the first case in which this method was used in 

 Calcutta by Capt. J. G. Murray, I. M. S., 10 in less than a week a cavity 

 originally containing about 500 cubic centimeters. (1 pint) of pus would 

 admit only 15 grams (one-half ounce) of the quinine solution. After 

 two weeks (an unnecessarily long time, to be on the safe side) the canula 

 was withdrawn, leaving a 10 centimeters (4-inch) sinus. In three 

 days the sinus had healed up to the surface with only a few drops 

 of serous discharge, and in a week from the removal of the canula the 

 skin had healed over and the patient left the hospital, striking contrast 

 to the slow process attending infected liver abscess wounds after the open 

 operation. The patient was discharged from the hospital in less than 

 half the time that any similar liver abscess evacuated through the chest 

 wall had been cured by the open operation in the European Hospital 

 during the last nine years. The great advantages of sterile siphon 

 drainage combined with sterile daily quinine irrigations is thus clearly 

 established, but the marked success of repeated aspirations and quinine 

 injections recently obtained promises greatly to limit the necessity for the 

 employment of my flexible sheathed trocar. 



THE USE OF IPECACUANHA IN" THE AFTER-TREATMENT OF AMCEBIC LIVER 



ABSCESS. 



Lastly, I would urge that every patient operated on for amoebic liver 

 abscess should be given a course of full doses of ipecacuanha as soon as 

 possible, with the view to healing the ulcers in the large bowel, which 

 have originated the hepatic trouble and are often latent and give rise 

 to no symptoms. This will greatly lessen, or entirely prevent, the for- 

 mation of further liver abscesses, the occurrence of which, during the 

 convalescence after operation for a collection of pus, is one of the most 

 trying complications the surgeon in the Tropics is liable to meet with. 

 If the operation is resorted to, the cavity should also be washed out with 

 sterile quinine lotion daily, as this will rapidly lessen the discharge if 

 no serious bacterial infection has resulted. As an example of the value 

 of this meausure, I may mention the case of an European who had been 



"•Loc. tit., 1330. 



