SURGICAL EXTRACTS. Four cases of injury to the Thoracic Duct occurring in the course of Suugical Operations.?Injury to the thoracic duct, in the course of an operation, is, so far as I can find, not referred to in English books on surgery ; and, indeed, injuries occurring apart from surgical procedures are only just referred to. Dr. Keen of Philadelphia, has collected four such cases ; the injury to the duct occurred in the course of operations'for thereraoval of deep-seated tumours above the left clavicle; three of the cases recovered and one died a few hours after the operation from shock. In each of the cases, injury to the duct followed by the flaw of a fluid, was at once which was quite white and milky in two of the four cases, and in the other two was serous and colourless j the absence ot coloui in these two latter cases was due to the fact that the patients had been fasting respectively 12 and 18 hours. In one of the cases where the nature of the injury was not recognised at the operation, it is estimated that the patient lost about three pints daily for four days, of a fluid like skimmed milk' which constantly oozed from the wound! This In connecwas one of the cases that recovered. tion with these cases, it is interesting to note that the dissections of Mr. Ward Brinton and others show that the thoracic duct does not by a single mouth at any means always open by the junction of the left jugular and subclavian, but sometimes breaks up into two or three ducts, or even into a delta, some of the branches emptying into each of these large veins and sometimes It is posinto "other deep veins of the neck. sible therefore that in some of these four cases, one of the branches and not the main trunk may have been injured. The occasional great height of the final curve of the duct in the neck is o-enerally recognised but worth recalling. The treatment of the three cases that recovered is interesting and differed in each case : Case i. The leakage occurred deep down in the wound, which latter was merely packed closely with salicylic wool, tightly kept in position by antiseptic baudages; patient made an uneventful '

recovery.

394

INDIAN MEDICAL GAZETTE.

Case ii. Nothing done at time of operation, but four days afterwards the wound was examined, and the point from which the liquid issued was caught by forceps, which were allowed to remain in place for three daj^s; patient gained one pound a day after the discharge was stopped and made a good recovery. Case iii. The injury was recognised at the operation and the two edges of the opening were seized with forceps, and the wound closed by means of the finest Hagedorn semi-circular needle and fine silk. Experimental researches on dogs, made by Boegehold lead him to the conclusion that the complete integrity of the duct is not absolutely necessary for the support of life; and the practical point to note, based both on clinical and experimental observations, is that in injury to the duct, death takes place either from inanition, or pressure on important viscera like lungs and heart, from the escape of chyle; but if you can stop this escape, either by pressure or suture, the patient has a good chance of recovery; for closure of the duct is by no means necessarily fatal. Busey records a case of miliary tuberculosis in which he found the thoracic duct completely occluded by a tuberculous thrombus, and yet there had been no signs of interference with the flow of chyle.? (The Medical and Surgical Re-porter, May 1894.)

erection.

The

tearing

[Oct.

1894.

of the erectile tissue ori-

ginated an inflammation that was aggravated possibly by the presence of the urethral discharge. The emissions, etc., have- very much improved under treatment by passing full-sized sounds, together with deep injections of glycerine of tannin; but the incurvation has only sightly improved under treatment by massage, inunc-

tions of protiodide of mercury and and electrolysis.?(New York Medical

atropine,

Journal,

May 1894.)

A New Apparatus for Administering Anaesthetics.?Dr. Louchon, of Orleans, has introduced a new apparatus for administering anaesthetics, the object of which is to force the vapour alone of anaesthetics into the pharynx through a tube passed into the nose or mouth. The apparatus consists of a receptacle or bottle of suitable size with a stopper traversed by two tubes, an inlet and an outlet tube, neither of which dips into the liquid ancesthetic, but both stop close to the stopper. The inlet tube is connected with a compressible bulb, which is fixed at both ends to the receptacle by a simple metallic frame. The outlet tube from the stopper is provided with a rubber tube of suitable length, which is introduced through the nose or mouth into the lower pharynx. The advantages of this apparaTraumatic Chordee after Internal Ure- tus must be considerable in operations on the throtomy.?Dr. Nelson says that the patient had face and its orifices, seeing that anaesthesia can be had internal urethrotomy performed on him in a maintained throughout an operation, without the New York Hospital three months previous to his manipulations of the surgeon being interfered seeing him. The condition then was as follows, with every now and again; this device, thereDuring erection the penis formed an irregular fore, besides saving trouble, shortens the operation and tends to diminish the loss of blood.? curve, the convexity of which looked upwards, and the man was practically impotent; associated (The Journal of the American Medical Assowith this were the following symptoms, etc., from ciation, May 1894.) which he had never previously suffered, viz., nocturnal emissions unconnected with dreams, inability to project his stream (waterfall in tj^pe lassitude, vertigo, etc. The sequence of events after the urethrotomy was as follows: The third day after the operation he had an erection during which something seemed to give way, and this sensation was immediately followed by profuse hemorrhage, and for three months after leaving the hospital there persisted a free discharge of pus (there was some discharge before operation); three ?weeks after the operation he first noticed the curvature, and states that it was as pronounced then as now; no pain has accompanied erection or ejaculation at any time. In this case there must have been an exudative inflammation of that portion of the corpus spongiosum that corresponds with the concavity of the incurvation; probably more than stricture tissue was incised during the operation, and the sheath of the corpus spongiosum was cut through leaving the erectile tissue unprotected or even wounded. This state of the parts being favourable to the tearing of the spongy body, it promptly took place during the distention accompanying the first