In multiple abscesses and in suppura tive pylephlebitis surgical measures are useless unless to open an abscess threat ening to rupture. In single abscesses operation may promise fair success, espe cially in the non-amcebic cases. In cases in which the abscess is discharging through the lung operation should be deferred if the patient's condition is favorable, as some recover spontaneously.
Direct opening of abscess of the liver with the knife causes no danger of peri tonitis if done antiseptically. The in cision must be free and lead directly to the abscess. It is advisable to make the opening as high as possible. It is useless to suture the liver to the parietal wound. Incision must be made early, and ex ploratory punctures are indicated as soon as pus is suspected. Chauvel (Archives Gen. de Med., Aug., '89).
Two cases of abscess of the liver impli cating the pleural cavity. Incision evacuated two quarts of fluid. Two large drainage-tubes were introduced, the cav ity washed out, and the antiseptic dress ing applied. The patient made a prompt recovery. Cabot (13oston Med. and Surg. Jour., Jan. 9, '90).
Following conclusions presented in re gard to hepatic abscesses: 1. Pymmie ab scesses do not call for surgical inter ference. 2. The same observations apply to abscesses resulting from suppurative phlebitis of the portal vein. 3. Multiple abscesses associated with dysentery or ulceration of the bowels are very unfavor able for surgical treatment. They must, however, be opened and treated on the same lines as the single or tropical ab scess. 4. Single abscesses of the liver must, if they approach the surface, be ened If the lbseesses have burst into the lung, pleura, pericardium, peritoneum, or kidney, and the position of the abscess can be clearly determined, it must be opened without delay. If the position of an abscess be only suspected and the pa tient be losing ground, the liver should be punctured in the most likely situations. 5. Hydatids of the upper and back part of the liver are to be treated upon the same lines. 6. Empyema, pericarditis, and peritonitis caused by rupture of an he patic abscess or hydatid must be promptly dealt with on general principles. Codlee (Brit. Med. Jour., Jan. 11, 25, '90).
Abscess following dysentery should al ways be opened freely as SOOD as exist ence has been determined. Incision eight
to ten centimetres. Curetting continued with a long curette, employing continu ous irrigation until water flows out clear. Hremorrhage never observed in forty cases reported. Fontan (Gaz. Hebdom. de Med. et de Chir., Aug. 25, '95).
An hepatic abscess, when seated in the upper and back part of the right lobe, is best treated by resection of a portion of the ninth or tenth rib, and transpleural laparotorny, the pleura being stitched to the diaphragm in the absence of adhe sions. -When the anterior portion of the liver is involved, the abscess should be exposed by anterior laparotomy, the edges of the external wound being stitched to the surface of the liver if practicable.
The inner surface of the abscess-eavity should not be scraped ; simple injections after incision are quite sufficient and less dangerous. Ricard (Bull. et. Mem. de la Soc. de Chir., 1-2, '96).
The point of election in liver-abscess is the most dependent part of the collec tion, or the point showing a tendency to rupture. In absence of this the points of election arc just below the ribs, or in the seventh intercostal space in mid axillary line. ln early operations, or be fore adhesions have formed, it is ad visable to open the peritoneal cavity first, and pack it off by gauze, preliminary to opening the abscess. The subsequent management is similar to that of ab scesses in general. John G. Cecil (Amer. Pract. and News, Apr. 17, '97).
The treatment of liver-abscess should be prompt, bold, and radical. No meas ure is successful which fails completely to evacuate the abscess and allow free drainage. This can be done with precision and safety only by incision. The line of incision is to be determined by the posi tion of the abscess. George B. Johnston (Med. Record, June 5, '97).
Bleeding of the liver recommended in acute hepatitis of dysenteric origin. 'Whether it acts by relieving congestion or by withdrawing a certain number of iniero-organisms and favoring leucocyto sis cannot bc told, but rapid improve ment follows, and the recovery is so com plete that no other form of treatment can bear comparison with it. Paul Rem linger (Revue de Aug. 10, 1900).