906

or molecules studding the general translucency of the body,their linear arrangement, the varying vacuole, closely ap-proximate in both worms; while the excess of the granulesin the body of the canine receives elucidation from theobservation of Dr. Lewis on the human worm, that "in thelater periods of their existence the plasma of their bodiesbecomes more and more granular." This granular condi-tion of the dead body of the canine obscured any deductionsas to an oesophagus or digestive tube which was fore-shadowed in the human while living, though on "the nextmorning the filaria" under observation by Dr. Lewis "hadbecome uniformly molecular," and ,all appearances sug-gestive of internal organs had vanished" (p. 252).

So much for the points of objection raised by Dr. Cun-ningham. That there are clear generic features commonto both worms is apparent, as well as minor divergencesin details of organism, partly dependent on the conditionof the worm at death and subsequently, but not to bethoroughly elucidated except by observations made upon the living canine embryos. The contour, body structure,faint linear markings, vacuole, are the same in both, subjectto modifications of detail. If minor details are to be re-

garded as sufficient to oppose the relationship, what is tobe said for the "various appearances presented by a singlehaematozoon" (Fig. 3 Dr. Lewis’s woodcuts), any one of whichmight have been rendered permanent or even further mo-dified by death ? and what inference is to be drawn fromthe absent vacuole, absence of all internal differentiation,contracted tail, and very pronounced strise of Dr. Cun-

ningham’s woodcut of the worm magnified 1000 diameters,when read by Dr. Lewis’s plates ? A comparison of thisexample with the living and dead sketches of Dr. Lewiswill show how unsubstantial becomes a denial of relation-ship based upon minor details of structure. Identity ofthe two worms is not asserted, and necessarily the featuresof the one cannot tally in all details with those of the other,nor can minor details differentiate when such divergence inthese details exists between individuals of the same speciesas has been shown. The anatomy of the parent canineworm is that of a!<M’M&mdash;Dr. Lewis regards his haematozoonas a filaria; it is hence difficult to understand on what

grounds Dr. Cunningham refuses the relationship of theembryo of the canine to the hsematozoon, generically alliedat least, and, I assume, closely approximated specifically.But whether or not my facts and reasoning bear me out Ileave for those who are competent to decide.

In conclusion, Dr. Cunningham has entirely misunderstoodthe object of my paper, which was to comply with a requestin Dr. Lewis’s report, that the canine filaria sent to Netleyshould be examined. The facts were thrown together toassist the elucidation of the natural history of the humanheematozoon as compared with that of the dog, and notto furnish a theme for acrimonious remarks, which addneither to science nor truth; nor are statements verified byscattering gratuitous insinuations, such as " bad and dis-torted specimens," and by slurring the method of working.Army Medical School, Netley.

OVARIOTOMY DURING ACUTE SUPPURA-TION OF AN OVARIAN CYST, THE

RESULT OF TAPPING;RAPID RECOVERY.

BY T. PRIDGIN TEALE, M.B., F.R.C.S. ENG.,SURGEON TO THE LEEDS GENERAL INFIRMARY.

THE following case. though by no means standing alone,is full of interest. It adds another to the small number ofthose who, being in extreme danger from inflammation ofthe sac resulting from tapping, have been rescued from im-minent death by ovariotomy; and it teaches ua not to bedeterred from an operation, even of the greatest magnitude,by the most acute and threatening inflammatory disturb-ances, where such disturbances are the result of a localisedlesion in a part admitting of removal.M. D-, unmarried, was admitted into the Leeds In-

firmary January 17, 1873. She stated that she came of a

healthy family, and that she had enjoyed remarkably goodhealth up to nine months before admission. At that timeshe had complete retention of urine for two nights, and wasonly relieved by the passing of a catheter. This symptomdid not recur. Three months after this she noticed a hardfixed tumour, about the size of a hen’s egg, in the left iliacfossa; this gave her severe pain, but did not prevent herworking. The tumour increased rapidly in size, but threemonths before admission it ceased to be painful. She losther appetite and became very thin ; she was, however, ableto work up to the time of admission.

I Jan. 19th.-The tumour was tapped with the pneumaticaspirator, and six and a half pints of dark-red thick fluidwere evacuated. A tumour, the size of a child’s head andfreely movable, could then be felt below and on the left sideof the umbilicus.20th.-She was very faint after the tapping, vomited,

complained of pain in the abdomen, and in the evening shehad a rigor.From this date to Feb. 6th she became rapidly worse.

The vomiting continued; she had frequent rigors; and thetemperature reached as high as 105&deg;, a,nd was subject togreat diurnal variations, varying from 3&deg; to 6&deg; between themorning and evening. She had much abdominal pain, andthe b0dy rapidly enlarged.

Feb. 6th.-Mr. Teale, in company with his colleagues,examined the patient. She complained of much pain; hadan anxious expression of countenance; pulse 130; tempera-ture 103&deg;. The abdomen was larger than before the tap-ping; and, on percussion, it was found that the anteriorregion, which was dull before, was now resonant, whilst theflanks, which tvere previously resonant, were now dull. Theopinion formed was that the sac was suppurating; that theanterior resonance was due to the gas of decompositionwithin the sac; and that the lateral dulness was the resultof recently effused fluid within the peritoneal cavity. Asher condition had become extremely critical, and her pro-spect of recovery without an operation was hopeless, it wasdetermined to perform ovariotomy immediately.

Operation -The patient having been placed under theinfluence of ether, an incision was made from the umbilicusto within an inch of the pubes. On opening the peritoneumseveral pints of ascitic fluid escaped, and the peritoneumwas seen to be red and coated with recent lymph. The

cyst was then tapped with a Wells’ trocar, and fetid gasand several pints of stinking fluid were evacuated. Theincision was then prolonged to the sternum, and numerousrecent adhesions to the abdominal wall and to the intestineswere broken down with the hand. The pedicle, being avery short one, was tied with strong whipcord and thendivided with scissors, the ends of the string being cut shortand returned into the abdominal cavity. The edges of thewound were brought together by several deep and super-ficial silk sutures. The wound was dressed with a pad ofdry lint and a flannel bandage.

On examining the cyst it was found that on the left sidethere was a solid portion about the size of a large cocoa-nut,and on the upper part of the posterior wall there was apatch the size of the palm of the hand in a state of incipientgangrene.The after-progress was most satisfactory. On Feb. 16th

the stitches were removed. On the 23rd the patient got upfor the first time; and on March 7th she was discharged,well, to the Convalescent Hospital.Remarks.-An interesting point of difficulty in diagnosis

arose in consequence of the inflammatory changes. The tu-mour was originally dull anteriorly, and was surrounded byresonant bowel free from ascitic fluid. By means of theinflammation the percussion was reversed. The sac, pre-viously dull and filled with fluid, became resonant from thedevelopment within it of the gas of decomposition; andthe surrounding resonance had been replaced by dulnessfrom the effusion of ascitic fluid, which masked the reso-nant bowel.

1 It would perhaps have been better - to have made theincision from the ensiform cartilage to the pubes at thebeginning, so that, if possible, the cyst might have beenremoved whole. We might thereby have avoided the evilof the escape of the fetid gas into the room, and the risk ofthe escape of pus into the peritoneal cavity.The following are, so far as I know, the only cases of

extirpation of a suppurating cyst which have been recorded.

907

1. By Dr. Keith: successful removal of a suppurating cystseven days after tapping. 2. Three cases recorded by Mr.Spencer Wells. 3. One case by Dr. Peaslee. 4. Dr. Wilt-shire’s case during acute spontaneous peritonitis.Leeds.

ON SUTURES, AND THE TREATMENT OFINCISED WOUNDS.

BY J. C. OGILVIE WILL, M.D.

SIJTURES are undoubtedly the best means we possess formaintaining the edges of cut parts in apposition. Unfor-

tunately their employment is attended by certain disad-vantages : such as the irritation, giving rise to suppura-tion, when silk is the substance of which they are com-posed ; the danger, during their removal, of tearing a,partloosely united surfaces; and the pain experienced by thepatient when they are constituted of metallic bodies.

Another grave objection to the use of sutures is, the un-sightly marks-consequences of suppuration-which remainat the points where they had been inserted. These cica-trices are of course chiefly objectionable in parts exposed toview, as in wounds of the face, &c. The object of the pre-sent paper is to draw attention to sutures formed of a sub-stance which can be employed without fear of the foregoingundesirable effects presenting themselves. This substanceis catgut, which Professor Lister brought into notice someyears ago for this purpose, but which he has since dis-carded, though he still retains it for ligatures. Regardingits use for the latter purpose I cannot speak personally, asI have always found acupressure answer every purpose;but with regard to the former I can speak most emphatic-ally, for during the last two years in every wound where Ihave had reason to expect early union-and it is only in suchcases that I advocate its use-I have invariably employedcatgut sutures, and their employment has been attendedby the happiest results. In proof, I may cite a few cases.

1. A child came against a pane of glass in a window,broke it, and in so doing almost severed the fleshy part ofhis nose from the cartilages. The surfaces of the wound,having been washed and exposed to the air for a fewminutes, were brought into apposition, three catgut sutureswere inserted, and cold-water dressing applied. In threedays the sutures were removed, and a day or two afterhardly a trace of the injury remained. The sutures did notgive rise to the slightest irritation.

2. An injury causing a somewhat similar but much moresevere lesion, the cartilage of the septum being fairlydivided, occurred to an old woman. In this case the edgesof the wound were very jagged. The same treatment was

adopted, with like results.3. Case of excision of the mamma. Eight sutures; one

vessel acupressed; pin removed seven hours after; imme-diate union. The sutures, not giving rise to the slightestinflammation, ,were allowed to remain till the thirteenthday after the operation, when they (or rather what remainedof them) were removed. Shortly after the points where thesutures had been inserted could not be discerned.

4. Another very striking case was that of a young childwho was brought to me with the point of his middle finger ’,hanging merely by a thread, like a piece of skin, the wholeof the other tissues, including the bone, having been di-vided. After carefully cleansing the wounded surfaces,and allowing them to become glazed, I brought them intoaccurate apposition, and inserted two catgut sutures, re-marking at the time to the boy’s mother, that I had littlehope of a favourable result, and that I would probably haveto remove part of the finger, but that I had given him achance. Fortunately I was not obliged to resort to such a.

proceeding, as the parts healed kindly, and on the sixthday I removed the sutures. On that day only one smallpoint remained unhealed.

5. Amputation of the third finger, with removal of part ofthe metacarpal bone, in the case of a boy. Three sutures;wound healed without the slightest suppuration. Thesutures were removed on the seventh day, when the childwas sent home perfectly well.

6. Same operation as last, on a man.. Three sutures; one

vessel acupressed; pin removed four hours after. (Edema.and slight suppuration, notwithstanding which the sutureswere allowed to remain; and on the twelfth day the woundhad entirely healed.

This case showed that catgut may be employed with ad-vantage in a different class of cases from that in which Ihave advocated its use, as, unlike wire, which will cut itsway out, and silk, which will resist, catgut will stretch to acertain extent. I might quote many other cases of woundsin other parts, but must content myself with the above-mentioned.

If surgeons will only give catgut sutures a fair trial, atthe same time not disregarding other essential precautionsto which I shall presently refer, I feel assured that theywill have every reason to feel satisfied with the results fol-lowing their use. The other points to be attended to, inthe treatment of incised wounds, are that there be noforeign bodies in the wound-such as blood, dirt, or 11 deadpieces of meat," as Sir James Simpson quaintly termed liga-tured vessels,-and that its surfaces be exposed to the airtill they have taken on a glazed appearance. This last in-dication is not, I am aware, in accordance with the viewsentertained by many surgeons at the present moment; but-experience here has proved that union takes place more readilywhen air has been freely admitted than when wounds havebeen hurriedly closed. It is probable that if there arespores in the air of other places, Aberdeen has its duesh3,re of them, but they do not exert the baneful influenceascribed to them in some other cities; and the fact thatunion by the first intention has been obtained here in somany instances of amputation, excision,* &c., after theyhave been exposed to free currents of air, for periods vary-ing in duration from ten to thirty minutes, seems to me tobe a proof that the germ-theory of putrefaction in woundsis hardly a tenable one. The only explanation that couldpossibly be given by the supporters of that theory wouldbe that the air in this city is pure and free from germs ;but to explain the why and wherefore of this exemptionwould be a still more difficult matter. Even if this couldbe done, it would not be sufficient; for in Edinburgh,where germs are supposed to exist in their highest degreeof development, I saw more than one case of wounds afterexcision of tumours unite without one drop of pus,-after SirJames Simpson, not content with the ordinary access of air,used a bellows to ensure every part of the raw surfaces being,so to speak, flooded with it. Further, regarding dressings,I find the less the better; when any are employed, a simplestrip of wet lint suffices. I have not thought it necessaryto enter upon the necessity of obtaining accurate coaptationof the edges of cut parts, as this point is so universallyrecognised as a sine qucc non in the treatment of incisedwounds that even mention of it seems superfluous. Thetreatment I have indicated is applicable to all incisedwounds; excepting that I would only counsel the use ofcatgut sutures in those of the slighter order, or in thosewhere, from the nature of the case, there is reason to expectunion by the first intention.

I may add that, as I have received several applicationsfrom medical men requesting me to obtain for them asupply of catgut, what I have employed has been preparedby Messrs. Young and Son, North-bridge, Edinburgh.Aberdeen.

A CASE OF LIGHTNING STROKE.

BY J. B. WILSON, M.D.,STAFF SURGEON, ARMY.

TEE scanty information that we possess both concerningthe first symptoms and the results following in cases of theabove nature, not at once fatal, induces me to record theparticulars of one that fell under my notice.The transient but unmistakable simulation of locomotor

ataxy that occurred during the progress of this case isanother recommendation for its publication, and I hope will

* "Since 1864 I have had examples of union by the first intention inevery amputation of the body, with the exception of the leg and at the hip-

joint (the latter operation I have not dnring that period had occasion to

perform), in excision of joints and tumours, and many other minor ope-rations.’-Professcr PiMiE, THE LANCM, July, 1871.