532 
M. H. REYNOLDS. 
(c) Destruction of accessible pyogenic microbes. 
(d) Removal of foreign substances, as splinters of wood or 
necrosed bone. 
(e) Establishment of an active granulating process. 
The first I strive to attain at any cost. I accomplish such 
drainage by the knife, trocar and canula, setons of cloth or 
rubber drainage tubing and a surgeon’s large pump. We 
sometimes need a seton that will remain in place for a long 
period and not decay. Horsehair, rubber tubing, shoe¬ 
makers’ linen thread or leather will answer this condition 
perfectly. I have never tried to trephine the scapula, but 
believe it can be done with advantage in those cases where a 
sinus runs down into the sub-scapular region ; at least, 1 shall 
certainly try the operation when the first favorable case pre¬ 
sents. In a few cases bottom drainage seems impossible. The 
only satisfactory substitute with me has been hydrogen per¬ 
oxide. The next condition is secured by digestant solutions, 
by curette, or by severe, but self-limiting caustics, like pure 
carbolic acid, or concentrated alcoholic solution of bichloride ; 
copper, zinc and the other metallic salts have not proven so 
satisfactory to me. Diluted nitric acid has given me good 
results, but my preference is ninety-five per cent, carbolic 
acid and the sharp uterine curette (human). Dilute bichlo¬ 
ride, dilute carbolic and peroxide have proven the most prac¬ 
tical antiseptics. The only" way to get rid of foreign substances 
is by bold surgery. The production of active, healthy granu¬ 
lations sometimes calls for all the ingenuity a surgeon can 
muster. Turpentine, ammonia, common salt solutions and 
diluted white liniment have all given good results, but the 
practitioner must be cautions in using them. Long contin¬ 
ued and repeated irrigations with hot dilute antiseptic solu¬ 
tions and even hot water, or hot and cold water quickly alter¬ 
nating in a steady current, will frequently transform a hope¬ 
less old chronic into a very interesting patient. A severe 
blister covering a large surface will sometimes bring about 
similar results, but is painful and frequently needless. I only 
use it in those cases where the discharge nearly ceases, but 
is annoyingly persistent. 
