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Published: 2015-07-07
Total Pages: 390
ISBN-13: 9781330866092
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Excerpt from Canada Lancet, Vol. 20 A chill and a temperature of 104 followed, but improvement went on again when the tube was re-introduced, and within a month recovery was complete. Case II. Man, aged 22. Pleurotomy in 6th interspace, right side, at the anterior axillary line. Drainage as before. Irrigations carried out at home. Tube gradually shortened until the sinus closed nine weeks after operation. Lung expansion complete and chest wall normal. Case III. Man, aged 20. Seen after spontaneous perforation had taken place in a 5th interspace in front - the usual point for such perforation in adults. Free drainage and antiseptic irrigations led to recovery with considerable condensation of the lung, and retraction of the ribs of the side affected. Case IV. In all essential particulars was similar to Case III. Case V. Boy, aged 4 years. Empyema pointing in 2nd interspace - the usual place in children. Thorough drainage after the manner of Cassaignac for a few days. Then the upper opening was allowed to close, and the discharge was received into absorbent antiseptic pads. Gravity injections were used only when flocculi occluded the sinus. Cure complete in about seven weeks. Case VI. A boy, aged 17. After a pneumonia involving the lower and middle lobes of the right lung had well advanced toward resolution, a relapse took place. Marked dulness corresponding to the fissure between the two lobes involved, was noted. Two days later the presence of fluid in considerable quantity was recognized, and I was asked by my assistant to see the case. I did so, and we removed by aspiration 70 oz. of pus. dema of the chest wall was well marked up to the level of the 3rd rib in front. As the flat line rapidly crept up again, I did pleurotomy and and established a syphon drainage, secured as before by rubber belt. About a pint of pus was washed out daily, or ran out into the bottle, which was placed on the floor beside the bed. Chills, fever, and heavy perspiration returning, we removed the tube and sought for the cause of the septicemia. It was noticed that two entirely different kinds of pus came from the wound, one thin and not offensive flowing from a sac that could be traced straight in toward the root of the lung for quite six inches; the other thick and very offensive, coming out from the lower and back part of the pleural cavity. Passing a Simpson's sound to the bottom of this latter collection, I cut down upon it, making a 21/2 inch opening, and drawing through from one opening to the other a rubber drain. This drain was threaded with horsehair to prevent its occlusion by clots, and its outer ends were coupled together by a bit of glass tube. The single drain was returned to the upper sac, which we now recognized as being an inter-lobar one. Gravity injections were made into each cavity, one or two quarts being used daily for more than three months. If these were omitted for even two days septic symptoms returned, and they had to be resumed. At about the end of the third month a pleuro-bronchial fistula formed. Iodine solution injected into the inter-lobar sac was coughed up, but none returned by the air tubes when injected into the lower pleural sac. Recovery was reached after about six months of constant attendance. A year later this patient was examined; his general health was good, and but slight difference was noticed in the expansion of the two sides of his chest. Air entered freely all parts of the lung on the affected side, and only the evidences of thickened pleural membrane were present. Regarding the diagnosis of empyema, the presence of an area of flatness on percussion, and of silence on auscultation where we should get resonance and normal respiratory murmur, calls for an exploratory puncture, which can safely and almost painlessly be made by a hypodermic syringe. Should the area spoken of be found in either subaxillary space, the presumptive evidence of the pre."
