Hydatid disease, Vol. II. By the late John Davis Thomas... A collection of papers on hydatid disease / edited and arranged by Alfred Austin Lendon.

  • Thomas, J. Davies (John Davies), 1844-1893.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Hydatid disease, Vol. II. By the late John Davis Thomas... A collection of papers on hydatid disease / edited and arranged by Alfred Austin Lendon. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

    161/188 (page 145)
    (3) Its prolonged duration ; probably three or four months on an average are required for convalescence, which can hardly be said to begin until the mother-cyst has escaped. (4) Its total inapplicability in some localities, e.g., for lung hydatids, or pelvic cysts. (5) Even when applicable to a given case, it cannot be depended upon to procure efficient adhesions. For these reasons, Recamier’s treatment should forthwith pass into disuse. (b) Canule-a-demeure.—The aims of this plan of treatment are identical with those of liecamier’s method, viz., to establish a free opening into the sac of the parasite, in order to extract its contents, and at the same time to establish adhesions, in order that none of the cyst contents should escape into the peritoneal cavity; there can be no doubt that this method represented a great advance upon the treatment by caustics, as is sufficiently proven by its lower death rate, and also by the fact that it can be adopted when the parasite is situated within the limits of the thoracic parietes. Tn ninety cases in which this treatment was employed for liver hydatids, there were twenty-four deaths, or at the rate of nearly twenty-seven per cent.; but this is better than the death- rate of the caustic treatment, which amounts to over thirty-three per cent. Three cases of splenic hydatid, however, so treated, all proved fatal. In a large proportion of the fatal cases, death took place from septicaemia, caused principally by imperfect evacuation of the cyst contents, w’hich generally soon become decomposed ; two of the deaths from peritonitis appear to have resulted from escape of the cyst contents into the peritoneum, and in one of them the canula had slipped out of the sac. The objections to the canule-a-demeure treatment are :— (1) The uncertainty as to the course of the canula; in most cases it is not difficult to avoid transfixing the intestine or stomach, but it is common to traverse the omentum ; but in the case, for example, of a pelvic hydatid projecting in the hypogastric region, it may easily happen that the urinary bladder may be carried up by the cyst, and that it may be transfixed by the trochar; it is needless to comment upon the prob- able result. (2) In the case of a deeply-seated cyst, it is quite common for the canula to slip out of the sac, in consequence of the collapse of the parasite, caused by the evacuation of its fluid contents. I have seen fatal pneumo-thorax caused in this way, by an attempt to treat a pulmonary