ABSCESS OP THE LIVER SUCCESSFULLY TREATED BY TAPPING. Br Dr. H. C. Civil
Bowser, Surgeon, Rungpor.
On the 4th July last, I was called to see Annundo Churn, a mookhtiar, suffering from an acute attack of hepatitis. I continued to attend the case for 4 or 5 days, when being disgusted
with the patient and his friends for neglecting my instructions, though I cltarly put before tliein the future danger of such neglect, I abandoned the case, and heard nothing more about it till the 4th August, when I was again solicited to see my former patient, who was said to he dying. I found Annundo Churn much emaciated, with a frequent feeble pulse, a pinched and anxious countenance, a fixed state of the abdominal muscles, and a short shallow thoracic breathing. On further examination, I found a large swelling, of about 6x4 inches, immediately below the ribs, and fluctuating distinctly about a couple of inches from the spinal column. I determined upon tapping this with a medium sized trocar, and drew oft' a little more than 10 ounces of most offensive smelling pus. The patient was much exhausted from the operation, and was obliged to be supported with stimulants the whole night. Next morning I found him cheerful, and he expressed himself quite refreshed by a good night's rest. He steadily continued to improve without a single bad symptom, gained flesh and strength, and was finally discharged cured on the 4tli September, exactly a month after being tapped. The treatment during the cure consisted simply of tonics and a generous diet, and the sac of the abscess was emptied morning and evening; the hand being laid flat on the seat of the abscess, following up, with gentle pressure, the exit of pus so as to exclude as much air as possible ; the opening into the abscess being kept patent by a pledget of oiled lint.
Remarks.
I have been induced to publish this case from a conviction that this mode of treating an abscess pointing externally in either the liver or spleen is to be preferred to either allowing it to burst of itself, or operating upon it by any other mode. In an experience ranging over 35 or 40 cases, I was much disappointed at losing every case under the usual treatment of trying absorption, opening with an ordinary abscess lancet, or allowing the abscess to burst of itself. In the first mode of treatment, I found that irritative feversoon carried my patientsoff, and in the two latter modes the accession of air iuto the cavity
November 1,
1867.]
PROMOTION IN THE BRITISH MEDICAL SERVICE.
caused much decomposition of pus, and inflammation of the walls of the abscess ensued. These failures induced me to try the operation of tapping as early as possible, the air by this mode being completely excluded. And the result since has determined me to always adopt tapping till a better plan suggest itself, for three successive cases, two of abscesses of the liver and one of the spleen, have made most speedy recoveries under the above noted plan of treatment.
273
Bowser, Surgeon, Rungpor.
On the 4th July last, I was called to see Annundo Churn, a mookhtiar, suffering from an acute attack of hepatitis. I continued to attend the case for 4 or 5 days, when being disgusted
with the patient and his friends for neglecting my instructions, though I cltarly put before tliein the future danger of such neglect, I abandoned the case, and heard nothing more about it till the 4th August, when I was again solicited to see my former patient, who was said to he dying. I found Annundo Churn much emaciated, with a frequent feeble pulse, a pinched and anxious countenance, a fixed state of the abdominal muscles, and a short shallow thoracic breathing. On further examination, I found a large swelling, of about 6x4 inches, immediately below the ribs, and fluctuating distinctly about a couple of inches from the spinal column. I determined upon tapping this with a medium sized trocar, and drew oft' a little more than 10 ounces of most offensive smelling pus. The patient was much exhausted from the operation, and was obliged to be supported with stimulants the whole night. Next morning I found him cheerful, and he expressed himself quite refreshed by a good night's rest. He steadily continued to improve without a single bad symptom, gained flesh and strength, and was finally discharged cured on the 4tli September, exactly a month after being tapped. The treatment during the cure consisted simply of tonics and a generous diet, and the sac of the abscess was emptied morning and evening; the hand being laid flat on the seat of the abscess, following up, with gentle pressure, the exit of pus so as to exclude as much air as possible ; the opening into the abscess being kept patent by a pledget of oiled lint.
Remarks.
I have been induced to publish this case from a conviction that this mode of treating an abscess pointing externally in either the liver or spleen is to be preferred to either allowing it to burst of itself, or operating upon it by any other mode. In an experience ranging over 35 or 40 cases, I was much disappointed at losing every case under the usual treatment of trying absorption, opening with an ordinary abscess lancet, or allowing the abscess to burst of itself. In the first mode of treatment, I found that irritative feversoon carried my patientsoff, and in the two latter modes the accession of air iuto the cavity
November 1,
1867.]
PROMOTION IN THE BRITISH MEDICAL SERVICE.
caused much decomposition of pus, and inflammation of the walls of the abscess ensued. These failures induced me to try the operation of tapping as early as possible, the air by this mode being completely excluded. And the result since has determined me to always adopt tapping till a better plan suggest itself, for three successive cases, two of abscesses of the liver and one of the spleen, have made most speedy recoveries under the above noted plan of treatment.
273
