HYOVERTEBEOTOMY. 461 



The attention required by the patients after the operation is of 

 the simplest kind, consisting in keeping the wounded surface 

 thoroughly clean and keeping up the flow of the pus. This will 

 at first make its escape through the upper opening, but will soon 

 find its way through the lower one, and so long as it is discharg- 

 ing the opening must not be allowed to close, nor must the seton 

 be moved. 



Puncture in the Middle and the Loioer Megions of the 

 Parotid. — These modes of operation are so nearly identical that, 

 with H. Bouley, we think they may with propriety be jointly con- 

 sidered. 



In these cases but Uttle attention to the anatomy of the part 

 is required. The growth of the purulent collection distends the 

 pouches, displaces the blood vessels and nerves, separates them 

 more or less from the parotid, and becomes more superficial, and, 

 in fact, may vdcerate through the skin and empty itself spontane- 

 ously. But this process is a very slow, tedious and painful one, 

 and subjects the patient to such a degree of suffering, that it be- 

 comes a duty imperative to interpose the resources of sui-gery for 

 its relief. 



The puncture in this case should be made as early as possible, 

 and at the fluctuating point, as with an ordinary abscess. It is 

 made with the bistoury, or, what would be better, with the olivary 

 actual cautery, by which the prevention of hemorrhage wiU be as- 

 sured. The opening thus made and cauterized, wiU, moreover, 

 have less tendency to close too rapidly, besides which the modify- 

 ing effects of the cauterization will have a highly advantageous in- 

 fluence upon the healing process. 



The opening of the pouch at its lower extremity has been 

 recommended when the purulent collection is small, or when con- 

 cretions of inspissated pus are supposed to exist ia the cavities. 

 It is done by first dissecting the wide and thin lower portion of 

 the parotido-auricularis, then of the base of the parotid, under 

 which the distended pouch is seen and punctm-ed. 



We remember a case where the collection in both cavities was 

 such that we had no difficulty in opening them on each side of 

 the neck, about on a level with the thyroid glands, the lower 

 operation with emphasis ! 



Puncture Through the Eustachian Tubes.— (hxiai^iev has in- 

 vented a tube, rounded at one extremity, a sort of hollow bougie, 



