they hold, is very small if free drainage to the outside is secured. McLeod considers that, in the circumstances, stitches will not hold in the soft and inflamed liver tissue; he also considers that, in the event of the incision having to be made in the thoracic wall, removal of part of a rib is unnecessary. On account of the liability of a rubber drainage-tube to become nipped when the emptying sac causes a want of correspondence between the wound in the abdominal or thoracic wall and that in the liver, and, also, on account of facility of introduction during the subsequent dressings, this operator uses metal drainage-tubes of suitable lengths— 4 in., 3¼ in., 2½ in., and 1¾ in.— with an oval lumen of 4/10 in. by 3/10 in. These tubes he introduces by means of a special guide.
The author's method.— The following easy, rapid, and efficient method of operating on abscess of the liver I have frequently practised, and can recommend. The necessary apparatus (Fig. 84), which can be made by native workmen, consists of a large trocar and cannula (a), 4 to 5 in. long, by ⅜ in. in diameter; a steel stilette (b) at least 14 in. in length; two metal buttons (c, d), ¼ in. at their greatest diameter, with long (½ in.), hollow, roughened necks into which the ends of the stilette fit loosely; 6 in. of ½-in. stout drainage tubing (c). While the ends of the drainage tubing are held and well stretched by an assistant, they are firmly lashed to the stem of the buttons, over the ends of the shorter (d) of which, for additional security, the tubing is also tied (c). Two large holes, to provide for free drainage, are now cut close to one end of the drainage-tube. The tube is then mounted on the stilette by inserting one end of the latter through one of the drainage holes and lodging it in the hollow neck of the distal button (e),and thereafter so stretching the rubber that the other end of the stilette can be inserted into the neck of the other button (d). When thus stretched the drainage-tube should be capable of passing easily through the cannula. The apparatus being so prepared and rendered thoroughly aseptic by soaking in carbolic lotion, and the direction of the abscess and its depth
