stuffs with iodoform gauze. Certain French surgeons recommend scraping the abscess cavity; most practise irrigation with some antiseptic fluid. These methods do not find favour with English or Indian surgeons.
The method of opening the abscess by caustics, formerly much in vogue, is now abandoned; equally so another method, also formerly employed namely, that of leaving a rigid trocar in the wound.
Treatment after operation.— For the first few days after a liver abscess has been opened the discharge is considerable, and the dressing may have to be changed frequently. Very soon, however, should the case do well, the discharge rapidly diminishes, and the dressing requires renewal only every other day or every three or four days. During the first week the drainage-tube, provided it be acting efficiently, should not be disturbed, more particularly as it may be difficult to replace. Later, it may be removed and cleaned, and, when discharge has practically ceased, cautiously shortened. It is a great mistake to begin shortening the tube before it is being pushed out, or so long as there is any appreciable discharge. If there is the slightest indication, such as rise of temperature, that pus is being retained, the drainage must be rectified and the sinus, if necessary, dilated with forceps and finger, and a full-sized drainage-tube introduced as far as it will go. If this does not suffice, a counter-opening may have to be made. Delay in remedying imperfect drainage is a serious, it may be fatal, error.
Should an abscess on being opened be found to be septic, or should it become so, it must be flushed out daily, or twice a day, with a weak non-mercurial antiseptic, and a counter-opening made if necessary. Quinine solution— 1 in 1,000 normal saline— is useful if much amoeba-laden discharge persists for a length of time.
After liver abscess has been opened and is draining well, temperature rapidly falls, and in a few days, or almost at once, becomes normal. Should fever persist, it is to be inferred either that the drainage is inefficient, or that there are more abscesses in the liver, or that there is some complica-
