SKYPHOSIS OR LORDOSIS.—Since 1883, Dieulafoy has practiced thoracentesis 180 times on 69 hospital patients and 200 times in his private practice, and never once has he seen the liquid become purulent after the operation. Whenever the liquid reached 1800 grammes (60 ounces) thoracentesis was imperative.
Treatment by irrigation of the pleural cavity is severely condemned by most authorities.
[The employment of irrigation in the cavity of the chest after the removal of purulent collection by incision or other wise is a precarious measure. Even ster ilized hot water has been attended with marked vital depression, amounting in some cases to collapse. The introduc tion of iodoforin with glycerin by swab bing over the surface or upon gauze tampons within the pleural cavity is not attended with the inconveniences of general irrigation, and proves more ef fective in correcting septic development. J. ..11CFADDEN GASTON, Assoc. Ed., An nual, '90.] Number of cases of empycma with fistula, treated by warn] baths. If the fistulous opening is below the level of the fluid, it is evident that if the pa tient inspires and expires freely there will be a current of water into and out of the pleural cavity much stronger than can be obtained by simple irrigation. Clumps of coagulated blood and fibri llated masses are by this means washed out which could not have been removed by simple lavage. The baths were given in boiled water cooled to the temperature of the body, and lasted ten or fifteen minutes. The general condition of the patients was much improved, and no accident was observed to follow this treatment. Zeman (Rev. de ThiIr., May 1, '97).
Case of empyeina in a child success fully treated by irrigation by submer sion, according to Zeman's method, after resection. S. S. Adams (Pediatrics, July 1, '9S).
Irrigation with a 4-per-cent. solution of bicarbonate of sodium used in a case of ernpyema in which incision, drainage, and lavage with boric-acid solntion had failed to prevent reaccumulation of pus. _Daily irrigation with the bicarbonate solution for five days effected a cure. L. lletances (La Rev. :Med. de Santo Domingo, Year 1, No. 2, 1902).
Authors agree in the following dan gers in aspiration or irrigation of the pleural cavity, viz.: ilemiplegia, follow ing cool solutions; death following as piration; fatal results also in cases of the use of an anresthetic; unusual depression from the sitting posture during aspira tion, relieved by assuming the reclining position. The cautions given have been to use warm solutions, or, better, no solu tions at all; and to stimulate with cog nac, strychnine, etc., previous to thora centesis.
[Richard Earte, of Philadelphia, bas never had an unpleasant result from washing out all old empyema; but it must be remembered, he says, that a con siderable number of cases are on record in which an injection, which may have been frequently repeated without serious consequences, has led to sudden death, or to the most alarming symptoms, prob ably from the sudden increase of press ure within the cavity, caused by a par tial closing of the outlet or by the use of too large a tube. The nature of the fluid employed can have had nothing whatever to do with these results, as equally bad results have followed the use of pure water. ("International En cyclopmdia of Surgery," Ashhurst, vol. vii, Supplement.) These results emphasize the risks at tending intrathoraeic irrigation. J. Mc FA DDEN GASTON.]