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
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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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    seventy hours, and for nearly the whole of that time a continu- ous stream was kept up through the pleural cavity of solutions •of carbolic acid and sulphate of zinc. The patient bore this with very little discomfort, such as there was being caused by the pressure and irritation of the canulse: •lie was able to sleep well, had no nausea, and took food well; there was no cough, the pulse was uniformly good, and through- out the time the temperature was slightly above 970 F., having the day previously been 102° F. The level of the reservoir of fluid was only a few inches above that of the chest, and altogether about no pints were transmitted, the temperature being generally between 6o° F. and 70° F., but no very special pains were taken to maintain this uniformly, as it had been found on all previous occasions that •the entry of fluid at the ordinary temperature of the air had been borne with perfect impunity. The appearance of the chest after this was remarkably changed, the intercostal spaces of the left side being very markedly drawn in; the whole side from this cause, or even from actual further ■change, presenting a retracted look. The auscultatory signs, if these could in any degree be trusted, seemed to indicate that there was contact between the costal and pulmonary pleurae behind to the base and at the apex in front; that there was breathing over these parts of the lung; and that a pleural cavity at the anterior base contained air and fluid. The heart was in its natural position. It would probably have been the best course now to have made a free opening and kept in a drainage tube. On November 24th, about 20 oz. of pus were removed, and a continuous irrigating stream of carbolic lotion kept up for ^nearly twelve hours. This was well borne, and was terminated before it was intended by the accidental displacement of the ■canulte. On December 3d, about 30 ounces were evacuated, and irriga- tion afterwards continued with carbolic acid and sulphate of zinc •solutions for about sixty-four hours. The canulse on this occa- sion were probably fiually displaced by the action of the patient, as towards the latter part of the time considerable local irritation was set up. On December 13th, an incision was made in the seventh -interspace in the axillary line, and about 20 oz. of pus let -out, a drainage tube inserted, and the cavity from that time washed out two or three times daily with solutions of carbolic •acid. On December 16th, the patient presented a very anxious and