144 The Philippine Journal of Science lan 



the abscess cavity by means of an artery clamp. Pieces of one- 

 inch iodoform gauze are placed on the liver surface immediately 

 around the rubber tube and covered by the lips of the incision 

 when the latter is finally sutured. After removing the packing 

 used for walling off the other viscera, the incision is closed in 

 layers, anchoring the tube to the edges of the incision with 

 silkworm gut sutures. To the ends of the iodoform gauze safety 

 pins are fastened to prevent the chance of losing them. When 

 the patient is returned to his bed, the distal end of the rubber 

 tube is placed in a large white bottle suspended from the middle 

 portion of the right side of the bed. 



This method has two very good features which make it the 

 operation of choice. These are the use of Ochsner's gall bladder 

 trocar, which obviates the chances of contaminating the peri- 

 toneal cavity by the avoidance of the overflow of pus in the 

 operative field, and the postoperative drainage by means of the 

 long rubber tubing. With our cases we have observed that 

 during operation the abscess cavity does not contract very much, 

 a fact which is especially true with old abscesses with relatively 

 thick walls. However, during the three or four days following 

 operation, much contraction takes place. In some cases this 

 was apparent from the accumulation of as much as a liter or 

 more of pus in the drainage bottle during the first twelve hours 

 following operation. As the pus passes through the tube 

 easily, we derive another advantage of keeping the operative 

 wound and the dressings perfectly clean. 



POSTOPERATIVE TREATMENT 



In the open operations described above all the drainage tubes 

 provided are just long enough to protrude out of the incision. 

 Fairly thick dressing is applied over the wound. This is changed 

 as often as demanded by the amount of discharge. - If the tube 

 is acting properly, it is not disturbed during the first week. 

 Later it may be removed and cleaned, and as the discharge 

 diminishes in amount, it may be gradually shortened. In the 

 majority of our cases the abscess cavity was not irrigated with 

 any kind of solution, while in a few others in which the discharge 

 showed amoebae quinine in 1 to 1,000 solution and fluid extract 

 of ipecacuanha in a solution of 1 to 500 were used. In cases 

 with intercurrent intestinal amoebiasis, emetine given intrave- 

 nously, 1 grain daily, and ipecacuanha, in salol-coated pills, were 

 administered. The value of emetine hydrochloride in extremely 

 ill cases cannot be overestimated, for we have saved many such 



