be
an
encouragement
to
treat
surgically pul-
monary cavities caused by abscess breaking iuto the lung from neighbouring organs, as in liver where in many cases drainage of the pulmonary cavity could be resorted to with ad-
abscess,
vantage seeing
how there exists
the walls of the
cavity
to
and the
THE SURGICAL TREATMENT OF
masterly
of
Dandridgb,
article
published
in
Cincinnati,
in the Annals
a
Sur-
of
gery for February 1894, lias formulated a series of conclusions as to how far it is justifiable to
pulmonary cavities by surgical means. pulmonary cavity may be grouped in two classes, (1) abscess of the lung, pulmonary gangrene and hydatid cyst; these conditions treat
Cases of
when localised should be treated with incision drainage. Peyrot speaks of this class as
and
lesions, in contradistinction to class; (2) diffused lesions, in which
the limited other
the one
may place bronchiectasis and tubercular cavities ; here the attempt to treat one focus only of these generalised diseases must be incomplete in most
instances, but
cases
where
one
one
is often confronted with
local lesiou dominates the
o-en-
O
eral state, and where it is feasible, the rule of drainiug tubercular abscesses existing in other parts of the body finds application here. In bronchiectasis, Douglas Powell speaks of
hopefully case
where
operative measures, after draining a cavity
pectoration
was
reduced
from
and quotes a the daily ex-
20ozs.
to
nil.
tubercular cavities, Powell says regard when situated in the apex drainage can that take place per vias naturnles and interference is not called for, but cases occur where the extent of the excavation, superficialness of the cavity, With
to
restriction
of the disease to
one
lung
and
exces-
sive secretion
have
strongly suggest external drainage. interesting fact that in nearly all the of abscess caused by foreign bodies that been operated on, the foreign body has
been
discovered
It is cases
was
an
opened.
of the
lung
sulted iu
a
accidentally
Lopez reports
when the abscess
14
cases
from all causes, where cure
in twelve
cases.
of abscess
operation
for
of the abscess
hepatic portion irruption to the lung pulmonary portion would theu alone contract after
require treatment. Concerning the technique
of the
is considered
that
a
sine qua
non
ut
operation
it
the site of
incision adhesion should exist between the opposing pleural surfaces. This can be tested before
PULMONARY CAVITIES. Professor
tendency
a
re-
This should
by introducing a sterilised needle and observing if movement takes place at the free end of the needle during respiration; this test can be verified at the time of incision by cutting cautiously when the transparent parietal pleura will appear thickened and of a dull white colour if the lung beneath is concealed by adhesions, whereas a healthy transparent pleura will permit of the movement of the underlying lung being easily seen. Adhesions may be induced by packing the superficial wound with gauze and waiting for a few days, or the lung incision
The exact may be sutured to the chest wall. situation of the cavity should be ascertained with
aspirating needle; and when localised should opened with the thermo cautery, using the aspirating needle as a director. The cavity is beBt packed with iodoform gauze. Before further extension of surgical procedures to lung cavities can take place, the means of localising and determining the size of these cavities must be perfected, as the difficulties are often very great in the matter of diagnosis. the be
an
encouragement
to
treat
surgically pul-
monary cavities caused by abscess breaking iuto the lung from neighbouring organs, as in liver where in many cases drainage of the pulmonary cavity could be resorted to with ad-
abscess,
vantage seeing
how there exists
the walls of the
cavity
to
and the
THE SURGICAL TREATMENT OF
masterly
of
Dandridgb,
article
published
in
Cincinnati,
in the Annals
a
Sur-
of
gery for February 1894, lias formulated a series of conclusions as to how far it is justifiable to
pulmonary cavities by surgical means. pulmonary cavity may be grouped in two classes, (1) abscess of the lung, pulmonary gangrene and hydatid cyst; these conditions treat
Cases of
when localised should be treated with incision drainage. Peyrot speaks of this class as
and
lesions, in contradistinction to class; (2) diffused lesions, in which
the limited other
the one
may place bronchiectasis and tubercular cavities ; here the attempt to treat one focus only of these generalised diseases must be incomplete in most
instances, but
cases
where
one
one
is often confronted with
local lesiou dominates the
o-en-
O
eral state, and where it is feasible, the rule of drainiug tubercular abscesses existing in other parts of the body finds application here. In bronchiectasis, Douglas Powell speaks of
hopefully case
where
operative measures, after draining a cavity
pectoration
was
reduced
from
and quotes a the daily ex-
20ozs.
to
nil.
tubercular cavities, Powell says regard when situated in the apex drainage can that take place per vias naturnles and interference is not called for, but cases occur where the extent of the excavation, superficialness of the cavity, With
to
restriction
of the disease to
one
lung
and
exces-
sive secretion
have
strongly suggest external drainage. interesting fact that in nearly all the of abscess caused by foreign bodies that been operated on, the foreign body has
been
discovered
It is cases
was
an
opened.
of the
lung
sulted iu
a
accidentally
Lopez reports
when the abscess
14
cases
from all causes, where cure
in twelve
cases.
of abscess
operation
for
of the abscess
hepatic portion irruption to the lung pulmonary portion would theu alone contract after
require treatment. Concerning the technique
of the
is considered
that
a
sine qua
non
ut
operation
it
the site of
incision adhesion should exist between the opposing pleural surfaces. This can be tested before
PULMONARY CAVITIES. Professor
tendency
a
re-
This should
by introducing a sterilised needle and observing if movement takes place at the free end of the needle during respiration; this test can be verified at the time of incision by cutting cautiously when the transparent parietal pleura will appear thickened and of a dull white colour if the lung beneath is concealed by adhesions, whereas a healthy transparent pleura will permit of the movement of the underlying lung being easily seen. Adhesions may be induced by packing the superficial wound with gauze and waiting for a few days, or the lung incision
The exact may be sutured to the chest wall. situation of the cavity should be ascertained with
aspirating needle; and when localised should opened with the thermo cautery, using the aspirating needle as a director. The cavity is beBt packed with iodoform gauze. Before further extension of surgical procedures to lung cavities can take place, the means of localising and determining the size of these cavities must be perfected, as the difficulties are often very great in the matter of diagnosis. the be
