SURGERY.
On a new Method of opening Abscesses, without leaving visible Ci-
catrices. By M. Leriche, Physician to the Lyons Dispensary.—The
inconveniences daily met with in opening abscesses by incision, or by
the application of caustics, have induced me to seek a less objectionable
method of effecting this object. My principal aim has been to avoid
the permanent marks left by the means hitherto employed, a point of
.much importance when the abscess occupies the neck or bosom of the
female. I shall be much gratified if I can prove to the profession, what
I am myself convinced of, that if my results hav£ not been crowned with
complete success, mv patients have at least been often spared the dread
which always attends the use of cutting instrumentsk
Although the method which I propose is apparently sufficiently sim-
ple, I have not arrived at it without repeated trials, both of the use of
different materials and of the mode of operating. I shall, however, give
in a few words the result of my researches.
My first idea was to employ wires of iron, silver, or lead ; the re-
sults were tolerably satisfactory, but their use was liable to three objec-
tions :
1st. The difficulty of procuring them everywhere.
2nd. The necessity of having a special instrument for their introduc-
tion, and the rather acute pain which the operation occasioned.
3rd, and lastly, the contact of a hard substance, irritating the inflamed
and already painful tissues.
I also tried threads of hemp, linen, and cotton ; all were liable to a
serious objection, which induced me to discard them altogether; they
became swollen by the moisture in which they were constantly immer-
sed, and thus opposed the exit of the pus. I remarked also that their
employment gave rise to a rather acute inflammation around the open-
ings. Might not this be attributed to the facility with which these sub-
stances become altered in their nature ? It also occurred when the
threads were previously waxed.
Silk thread is the material on which I have decided, from its having
the following advantages over the others. 1st. It is to be had every-
where. 2ndly. It is not liable to become altered during the time it is
required to remain in the abscess. 3rdly. It does not absorb the mois-
ture. 4thly, and lastly, it does not irritate the painful parts with which
it is in contact. The silk thread which I use is known in the shops
under the name of twist (cordonnet).
After having shaved off any hair on the tumor, the surgeon takes a
curved ligature needle, passes through its eye one end of the silk twist,
then introduces the needle into the tumour, about six or eight lines from
the most depending part, where it must be brought out, draws the thread
into the passage formed by the needle, and retains it in this position by
uniting the two ends in a knot; the entire tumour is now covered with an
emollient poultice, which, in this case, acts mechanically. The patient
should remain as little as possible in bed, in order to favour the escape
of the pus along the thread, an effect which tikes place with difficulty
in the recumbent position, when the abscess is situated on a part of the
trunk or limbs. The poultices have also, in this case, the advantage of
diminishing the inflammation which is excited, and which the practitioner
must watch. The twist is to be left undisturbed for four, six, or eight
days, according to circumstances; most frequently four days have suffi-
ced. Subsequently, when thought advisable, the twist is removed, and
the part is dressed with dry compresses, or, when necessary, with com-
presses soaked in aromatic wine. In not one of thirty-three buboes
which had arrived at the stage of suppuration, and which had been trea.
ted in the manner just described, have I been obliged to abandon this
plan for any other. In cases of simple buboes, that is, those in which
the pus did not seem to possess specific characters, the cure has been
-effected in from fifteen to twenty days ; in the opposite cases, when the
orifices of the little openings ulcerated, it has occupied from forty to
fifty days ; and in neither case did the patient retain any trace of
syphilitic infection.
When the tumour has been tardy in reaching the suppurative stage,
the pus is sometimes contained in cellular pouches, in which case it may
happen that at the time when one thread seems to have effected the cure
of an abscess, another forms ; under these circumstances a second
thread must be introduced.
In other cases, the thread has brought on severe inflammation and
caused intense pain. When this occurs it must be removed, and lightly
astringent unctuous applications, such as Goulard’s cerate, substituted
for the poultices; to these should be added the employment of general
measures, baths, regimen, &c. &c.
But the selection of the means most suitable to combat the symptoms
which may have arisen must, in such cases, be left to the judgement of
the practitioner.—Dub. Quar. Journal, from Revue Aledico-Chirurgicale
■de Paris.