After the last operation the cyst did not fill again, and when the girl left the hospital a month afterwards, there was slight curving of the spine with the convexity to the left ; the right shoulder and angle of the scapula were a little depressed ; the edge of the liver was felt one inch above the umbilicus, and its upper border was on a level with the nipple. Its sub stance felt normal to the touch, and there was no distention or tenderness of the belly. Six months afterwards, when the child was seen again, the liver had returned to its normal size ; the spine was perfectly straight ; the shoulders were on the same level, and no indication was left that the girl had ever been ill.
Injection of iodine after the evacuation of the contents of the sac is not necessary to the success of the operation. It is usually found that simple emptying of the cyst is sufficient to destroy the life of the hydatid and that irritating injections are useless. In every case the child should be kept very quiet for a day or two after the puncture, and a firm bandage should be applied to the belly. It is well, also, to give a little opium at night, as was done in the case above narrated.
A sufficient time should be allowed to elapse after evacuating the fluid before repeating the operation. The cyst will often seem to be filling up again for a time ; but, if left alone, it frequently subsides without further interference and gradually becomes obliterated.
Dr. Fagg has reported several cases of hydatid tumour of the liver in children which he had treated by electrolysis in the manner recommended by Dr. Althaus. The operation was performed by passing two electrolytic needles into the cyst, one or two inches apart. The needles were then at
tached to two metallic wires both connected with the negative pole of a galvanic battery of ten cells. A moistened sponge formed the termination of the positive pole ; and this was placed on the patient's skin, at a little distance from the points of entrance of the needles. Its position was changed from time to time during the operation. After the current had passed for about ten minutes, the needles were withdrawn and adhesive plaster was applied to the seats of puncture.
The operation was usually followed by a little febrile disturbance and some pain ; but no immediate effect upon the size of the tumour was dis coverable. Indeed, the children were sent away from the hospital in much the same state as when they were admitted. But examination, after a period of months, usually detected considerable diminution in the dimen sions of the cyst. The operation appears, therefore, to be attended by no danger ; but its results are too slow in making themselves manifest to ren der it suitable for adoption in private practice. With regard to the modus operandi of the procedure, Dr. Fagg suggests that the gradual subsidence of the tumour may be due to slow oozing of the hydatid fluid through the punctures made by the needles ; for hydatid fluid alone, unaccompanied by ova or scolices, appears to be innocuous when extravasated into the peritoneum.
If suppuration have occurred in the sac, and the matter withdrawn be putrid and offensive, the cyst must be washed out frequently with a weak antiseptic solution ; opium should be given to allay pain and irritation ; and quinine in full doses, with nutritious diet and stimulants, will be required.