180 ENTOZOA FOUND IN MAN. 



The possibility of not producing adhesion between 

 the abdominal parietes and the tumour is a much 

 more serious objection. It appears probable, however, 

 that m those cases in which the apphcation of the 

 caustic failed to procure adhesion, the want of success 

 was attributable either to the improper management 

 of the case, or to the circumstance that the opening 

 was effected too soon, by the additional employment 

 of a trocar and canula. 



It is evident that, in order to procure sufficient 

 adhesion, the action of the caustic must extend to 

 the tumour itself, and that the number of applica- 

 tions must be proportioned to the thickness of the 

 structures through which the perforation is to be 

 effected. In the successful cases detailed by Dr. Da- 

 vaine the average number of apphcations was four 

 or five, with an interval of one, two, or more days 

 between the applications of the caustic. 



An incision into the cicatrix, or the removal of a 

 portion of it, before each fresh employment of the 

 caustic, will greatly accelerate the process, whilst it 

 will also, at the same time, enable the operator to 

 ascertain the extent to which the parts have been 

 destroyed. 



Until recently, it was generally supposed that the 

 opening of a cyst situated in an internal organ, and 

 especially in the hver, would always lead to the death 

 of the patient ; and, although experience has proved 

 that this opinion is no longer tenable, the question 

 has been raised whether, in the case of a hydatid 

 tiunour which does not give rise to any grave symp- 

 toms, nor to any inconvenience to the patient, it is 

 not preferable to postpone operative interference. 



