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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    Unfortunately the accumulation of pus was at times so rapid that distension beyond what had been intended could not be pre- vented. On September 27th, nearly 60 oz. of pus were removed, a large proportion of this being obtained by the washing process. Be- tween 9 and 10 pints of carbolic acid solution were used, and for the final washing a solution containing two grains of iodine to the ounce, and made up with glycerine to a specific gravity of 1060. After this tapping there were evidences of air in the pleura, and these continued to be noted with more or less distinctness afterwards until the time when a free incision was made, and rendered such signs as might be supposed to be given by the lung itself still more uncertain and puzzling. On October 10th, 114 oz. of pus were withdrawn, that which was first obtained being discoloured from the presence of the iodine of the previous tapping. This time there was an extreme irregularity in the way in which the pus was obtained, the wash- ing being continued for three successive times until the fluid returned was nearly clear, and then suddenly a large proportion of pus being obtained, as if the cavity were more or less separated into compartments by the presence of coagula or partial adhe- sions preventing the ready movement of fluid. This irregularity led me to take special note of a defined patch of dulness which was left after the tapping at the base behind, and to surmise that this might be due to a separate collection of fluid. It would appear that this was so, as upon tapping this part on October 13th, the pus obtained was of a different colour to that of the 10th, being free from the tinge due to the presence of iodine, which had been used both on October 10th and Sep- tember 27th. The quantity of pus obtained on this day was 26 oz., which was washed out with about four times its volume of carbolic solution. On October 21st, 44 oz. of pus were removed by the washing process, about 6 pints of carbolic lotion being used, and the final washing being with an ipdine solution. On October 27th, 32 oz. were withdrawn in a similar manner. On November 3d, 6^ oz. were obtained by a carbolic acid washing, no iodine being used ; the completion of the operation was prevented by an accident. On November 5th, 49 oz. were removed by a carbolic acid washing. On November 10th, about 25 oz. were withdrawn by washing: the two canulce were afterwards retained in place tor nearly