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.

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    On March 31 he was tapped in the ordinary manner, the aspirator being used, and about 48 oz. of clear serous fluid were withdrawn. It did not appear at the time that a sufficiency of the fluid present was evacuated, and I suspected that the cessation of flow was due . to the presence of subdivisions in the fluid-containing space, or to the blocking of the canula by a coagulum. There was, however, a return of the heart to nearly its natural position, and respiratory sounds were heard somewhat lower than they had been. Beneath the clavicle and towards the mammary region the freer entry of air brought out more distinct morbid sounds, and there were to be heard various irregular, creaky, and crepitant sounds; in fact, the physical signs here were in all respects such as would certainly, taken alone, have given rise to the diagnosis of phthisis. The shortness of breath was relieved by the tapping, but there shortly began to be signs of an increase in the effusion, and a second tapping appeared to me to be called for, but was postponed on account of a slight attack of gout. The patient afterwards passed from my care to that of Dr. Southey, who, on account of the doubtful signs at the left apex, was indisposed to interfere with the effusion. He left the Hospital on May 24. On July 14, 1880, he presented himself at the Chest Hospital, where he was admitted under my care. He complained then of extreme shortness of breath, and could lie only on the left side. He had recently been troubled with some pain over the left side of the chest, but had no night sweats, and had been able to sleep fairly, and had kept up a fair appetite. He presented no lividity, the pulse was of fair volume, the temperature slightly above 990 F., and the condition of the urine normal. There was a bulged appearance over the base of the left side; absolute dulness over the whole left side of the thorax up to the clavicle, and extending to nearly the right border of the sternum at its upper part; tympanitic resonance in the left supraclavicular region. Complete absence of respiratory sound over the whole of the left side, with exception of faint tubular breathing near the root of the lung; absence of vocal vibrations, and marked transmitted pulsation from the heart over the lower part where the bulging was most noticeable. Breathing on the right side was harsh. The heart’s impulse was to be felt in the fourth right interspace, two inches beyond the sternal border.. The day after admission be was tapped with a fine exploring trocar connected with a bottle aspirator, and six pints of laudable pus were slowly withdrawn, greatly to his relief. The physical signs after this tapping were on the whole cer-