142 The Philippine Journal of Science 1917 



pneumothorax when the incision opens or crosses the pleural sac. 

 The diaphragm and the chest wall are finally sutured and the liver 

 explored with a needle. If abscess is found, it is either incised 

 or left alone for forty-eight hours, allowing parietovisceral ad- 

 hesions to form, before incision is made. A short rubber tube 

 is used for drainage. 



Abdominal route. — ^While all the operations of this type are 

 essentially the same in principle, there are important differences 

 in the technic either for attaining better asepsis or better 

 drainage. 



The principle of Hanson's method is briefly as follows: A 

 trocar and cannula 9 millimeters in diameter and 10 centimeters 

 long is used. Through this a rubber drainage tube stretched by 

 a long stilette, the extremities of v/hich are placed in buttons tied 

 into the ends of the tubing, is introduced. The trocar and can- 

 nula are thrust into the liver, and the tubing is stretched by the 

 stillete introduced inside the cannula after removal of the trocar. 

 The cannula and the stillete are then removed, allowing the rub- 

 ber tubing to contract and fit snugly into the punctured wound 

 in the liver, thus preventing the escape of pus and thereby con- 

 taminating the serous sac and at the same time lessening the 

 chances of hemorrhage. Cantlie(34) reports 82 per cent re- 

 coveries in 100 cases by operation of this method. 



Rhoads, (35) realizing the possible dangers associated with 

 aspiration as a method of locating the abscess, and the uncer- 

 tainty of obtaining reliable information, advocates direct pal- 

 pation of the liver through a high, right rectus incision in every 

 suspected case, as a more satisfactory method for locating the 

 pus collection. If the abscess is located in the lower part of the 

 right lobe, lobus Spigelii, lobus quadratus, or the left lobe, eva- 

 cuation is accomplished as follows according to the words of the 

 author : 



The assistant being ready with gauze sponges clamped to carriers, an 

 incision 4 cm. in length and 1 cm. or more in depth is made through the 

 capsule. If this has not reached the pus, a closed broad-ligament clamp 

 is pushed through the opening, past the fibrous boundary of the abscess 

 and into the cavity, opened so that the blades are separated at least the 

 length of the surface cut, and withdrawn. The fibrous wall is very dense 

 in some cases, varying from .5 cm. to 2 cm. in thickness, according to the 

 age of the abscess, and may require considerable force to overcome its 

 resistance as the clamp is pushed through. As the thick, brownish-yellow 

 pus appears along the path of the instrument, the assistant sponges it away 

 rapidly from the opening, as little of the material as possible being permitted 

 to flow over the gauze protecting the intestines. The clamp is inserted on 

 successive times as the flow lessens until the cavity has emptied itself, and its 



