TIIORACIC DUCT. — ThiS may be the seat of disease through the extension of inflammation in the various forms of me diastinitis; or it may be itself in a mal condition and be the recipient of direct or indirect pressure sufficient to rupture its walls with extravasation of contents. Again, it is often the only part involved in a stab-wound of the mediastinum. The chyle cannot be lost to the system without serious results, and most wounds of the thoracic duct are fatal. At times, however, spontaneous closure of the wound occurs, when the incision is a longitudinal one.
[A recent ease of recovery reported by H. W. tyne, of Richmond, Va. (Virginia Med. Semimonthly, Aug. 26, '97) demon s.trates the possibility of so desirable an ending.
The thoracic duet was ruptured, and closed spontaneously in the case of a child reported by Kirchner (Arch. f. klin. Chin, 'S5, p. 156). The displacements of heart, liver, and other organs was very marked.
The treatment in this case consisted in a puncture and evacuation of a portion of the fluid, followed by active purgation. The child had been violently thrown against a window-sill, so that she was in jured about the level of the third rib. The puncture revealed the fluid extrava-..
sated to be chyle. Six months after the accident, the girl is described as being in better health than before it.
The wounds of all kinds have been few if they have been recorded. W. NV. Keen, of Philadelphia, has had one case of operation-wound of the thoracic duct. The wound was sutured very carefully with the finest semicircular Hagedorn needle and fine silk, and no untoward result oecurred. The weight of the pa• tient was carefully taken for some days after the operation and no great decrease was noticed. Keen records three other
cases of wounds in the cervical portion of the thoracic duct.
These cases were also operation wounds. One, that of Cheerer (Boston Med. and Surg. Jour., '75, p. 422), died from exhaustion. Another case was Boegehold's (Arch. f. klin. Chin, '93, vol. xxix, p. 443). Wilms was the operator, and the patient recovered. The third case was in an operation of A. M. Phelps, of New York, who communicated the facts to Keen personally. The operation occurred June 4, and on June I lth the wound was closed by limmostatic forceps, and the patient recovered, beginning to gain in weight after the closure.
Twenty cases of wounds of all kinds are mentioned, and many observations made during the treatment of them, leading to the inference that the duct was closed spontaneously in some of these cases and a collateral anastomosis was established; but the continual es cape of chyle may cause death by the pressure of the extravasated fluid, result ing in pleuritis, or that death may be attributed to the immediate exhaustion, as in Cheever's ease.
The usual size of the thoracic duct is that of a goose-quill, and the jet of chyle will be of low pressure and about the diameter of a straw. The junction of the left subclavian vein with the jugular vein is the site for the mouth of the duct to be found, but anatomists call attention to the somewhat frequent change in the location, due to the fact that the duct may empty its contents into the left subclavian vein by several mouths, comparable to the delta of a river (Med. and Surg. Reporter, May 12,