tube is allowed slowly to resile towards the fixed end still held in contact with the back of the abscess. When the drainage-tube has completely contracted, the stilette is withdrawn. The drainage-tube is then transfixed with a safety-pin inserted close to the skin, and the superfluous tubing cut off. Pus flows freely from the tube, which now firmly plugs the wound in the abdominal wall and liver, and bridges the peritoneal cavity. When the abscess has nearly emptied itself the usual antiseptic dressing is applied. In operating through the thoracic wall, if deemed desirable, part of a rib may be excised before the trocar is introduced.
I claim for this operation that it is easily done, and that it may be undertaken by the merest tyro in surgery and in the absence of skilled assistance; that there is no risk from bleeding; that, the peritoneum being bridged across by the drainage-tube which is securely grasped by the liver tissue, there is no risk of escape of pus into the peritoneal cavity; that in a very short time lymph is effused around the tube, giving additional security when, after a time, the tube has become loose; that, if deemed necessary, a larger drainage-tube, by stretching it on the stilette in the same way as described, can be substituted for the ½-in. tube; that an abscess deep in the liver can be as readily opened, and with as little risk, as one lying near the surface; that the shock is much less than in the cutting and tearing operation; that there is no risk of pneumothorax should the pleural cavity be traversed ; and that the drainage obtained is equal to that secured by any other method of operating. Several of my surgical friends have adopted this method of operating, and have expressed great satisfaction with the ease with which it is performed, and with the results.
Other operations.— Some Continental surgeons recommend extensive incision of the liver, using a Paquelin's knife with the view of minimizing bleeding. Zancarol, for example, advises that the hepatic and integumental incisions should extend the whole breadth of the abscess cavity, which he mops out and
