Report of cases of empyema treated by irrigation : with remarks upon the operation of paracentesis thoracis / by Philip J. Hensley.

  • Hensley, Philip J.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Report of cases of empyema treated by irrigation : with remarks upon the operation of paracentesis thoracis / by Philip J. Hensley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    17/22 (page 93)
    (3.) If there should at any time be a cessation of flow in con- sequence of the blocking of the orifice of the canula by the entry into it of coagulum, this can probably be washed back and cleared by raising the bottle above the level of the chest. I have tapped many cases of serous effusion in this manner, and have found that if the canula be well placed in the first instance, there is never any difficulty in evacuating a quantity of fluid which, if at all less, cannot be very much less than the quantity which would be obtained if more forcible exhaustion were attempted. No bleeding is ever caused, and the fineness of the canula and the comparative slowness with which the fluid drains away makes the operation one which is borrte with but little discom- fort. Some that have been treated in this way in the out-patient room have walked home afterwards and done well in every way. In but few cases of pleuritic effusion—probably in none except those of mere passive dropsical effusion—is it to be supposed that the condition of the lung and pleura is such that it is possible immediately for expansion to take place so completely as to displace all fluid from the pleural cavity ; and were this possible, the position of the canula would hardly ever be so exactly right that all would be actually displaced. No forcible attempt to remove the residual fluid can, I believe, succeed; nor in the case of a serous effusion would there seem any- thing to be gained by the replacement of this fluid by some other. The absorption of serum is probably a very simple process, scarcely one of pathological repair, and not likely to delay the other neces- sary reparative changes in the lung, pleura, and chest walls. It is quite otherwise, however, if the fluid be pus. If pus be left,, there is a considerable probability that fresh pus will be formed. Even if absorption commence, this must be a process causing a great amount of constitutional strain, and convalescence must be considerably delayed and impeded beyond what it would be if there were relief from the necessity of this absorption. Now, although the residual fluid cannot be removed by any forcible exhaustion, it may, as in the above cases, be more or less completely replaced by some other fluid, which it may be hoped may be easily and harmlessly absorbed as the reparative changes go on around it. To effect this it is only necessary to add to the above-described arrangement a branch leading to the canula from a reservoir of fluid raised above the level of the chest, and to have the means by taps or compressing clips of interrupting the communication of the canula with this reservoir above, or with the reservoir below, as may be required.