HYDATID CYSTS IN BOTH LUNGS.

Summary. It is obvious from a study of the above cases, in which the patients were nearly all treated by different surgeons, that the accepted treatment is by resecting portion of a rib 01 ribs over the cyst as localized by X ray examination, by evacuation of the mother membranes after complete tapping, and then by fixation of the cyst wall to the parietes with a diaainage tube in. situ for five to ten days 01 until such time as the discharge disappears. That is to say, in most of these cases treatment has consisted of open drainage. Only one patient received closed drainage; that is, an airtight junction of tissues was made around the tube, which was carried into a pail of lotion under the bed. Provided the hydatid membrane had been completely removed, this would hasten the recovery of the pneumothorax which occurs inevitably in all the cases. I n this case, too, an attempt was made to aspirate the pneumothorax could quickly be controlled by the use of one of the modern suction forms of apparatus, sirch as the electrical apparatus describetl by Bennett Jones in The British iMedicul Jountal of September 25, 1937, or the steam‐actuated suction shown by Doyle in THE AUSTRALIAN AND Nna ZEALAND. JOURNAL OF SURGEKT of October, 1937. The iise of cyclopropane‐oxygen under positive pressure may prove to be the best solution, as already me11 tioned. Since the distrew attendant on A pneumothorax depends largely upon the suddenness with which it arises, there seems to be il good argument fo1 the induction of an artificial piieumothorax a few clays before the plenral cavity is opened. This was successfully carried out in one of the cases. The use of a pneumothorax niiglit also ticcelernte the progress of a deep seated cyst towards the pleural surface, and shorten the time of waiting before the operation is carried out. Deep seated cysts are best treated by delay until the growth causes them to approwh the pleural surface, if they are kept meantime undei+ serial X rap observation. The period of waiting is fraught with (laager of rupture, either by pressure‐erosion of a bronchus or by infection, with consequent sudden increase in size of the cyst,. Both these complications are freely illustrated in this series of bilateral pulmonary hydatids. When a cyst I I ˜L S ruptured, the incompleteness of natural evacuation and the presence of toxamia are indications for operative intervention.