. Modern surgery, general and operative. portion of the erector spinae sheath is incised. The quadratus lum-borum muscle is next cut, and then the anterior leaflet of the lumbar aponeu-rosis is slit. The abscess is thus reached and opened and tuberculous pusflows out. The abscess-cavity is irrigated with ciuantities of warm corrosivesublimate solution (i : 5000). The cavity is tilled, the fluid is allowed to flowout, its exit being aided by pressure in front and changes of posture; the cavityis filled again, and so on, and, after all loose debris is removed, the bodies ofthe vertebras are care
. Modern surgery, general and operative. portion of the erector spinae sheath is incised. The quadratus lum-borum muscle is next cut, and then the anterior leaflet of the lumbar aponeu-rosis is slit. The abscess is thus reached and opened and tuberculous pusflows out. The abscess-cavity is irrigated with ciuantities of warm corrosivesublimate solution (i : 5000). The cavity is tilled, the fluid is allowed to flowout, its exit being aided by pressure in front and changes of posture; the cavityis filled again, and so on, and, after all loose debris is removed, the bodies ofthe vertebras are carefully examined with the finger and diverticula are pieces of bone are removed by spoons or forceps, and cavities are thor-oughly but lightly curetted, as in some places the wall is very thin. By meansof properly shaped spoons carious bone can be removed even from the anteriorsurface of the column (Treves). Thus the wall of the abscess is completelyremoved. Finally, all debris is washed out by irrigation with mercurial solu-. FiG. 492.—Aspirator and injector. tion; any mercurial solution which might remain is washed out by warm wateror salt solution, and the interior of the cavity is wiped dry. At this stagemost operators introduce iodoform emulsion. Whether or not this is done,the wound is closed by a series of silkworm-gut sutures, passed sufficientlydeep to include the greater part of the muscular and tendinous structures withthe skin (Trevess Operative Surgery). Trevess operation gives a highmortality. Aspiration of Joints.—In certain cases of joint-effusion from inflamma-tion, tuberculous or otherwise, and sometimes in hemorrhage into a joint, it isdesirable to remove the fluid by aspiration. The pneumatic aspirator () is used. The trocar and cannula are thoroughly asepticized and the jointis prepared as for a set operation. The needle is entered at a point free fromlarge vessels. The directions for using an aspirator are as follows: insert thestoppe
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