Report of a case of empyæma, with operation for closure of pleural cavity by removing portions of four ribs, with remarks / by A. G. Miller.

  • Miller, Alexander Gordon.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Report of a case of empyæma, with operation for closure of pleural cavity by removing portions of four ribs, with remarks / by A. G. Miller. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    evacuated. The incision was made below the angle of the scapula in the ninth intercostal space. As drainage was not perfect on account of the rising of the diaphragm, a second opening was made on 20th July, by removing a portion of the ninth rib. 6'J9c?•a^^■o?^.—Considerable difficulty was found in administering chloroform, as the patient had to be laid on his right side, and partly on his face, to admit of the necessary manipulations, and this materially interfered with the expansion of the right lung, on which he had to depend for respiration. An incision was made at once down to the rib immediately above the previous wound, the rib exposed, the periosteum separated, and about an inch of the rib removed with the bone pliers, after being partially sawn through with a Hey's saw. There was little bleeding, and a knife was then pushed through the posterior layer of periosteum and costal pleura, and a permanent opening established by inserting a large-sized drainage tube. At this operation two drainage tubes were recovered which had previously been sucked into the cavity, notwithstanding ligatures having been attached to them. On examination with the finger, the pericardium and contracted left lung were easily felt, both covered with granulations; the latter apparently firmly tied down to the vertebral column. After this operation patient improved very much for some weeks. Oct. 5th, 1883.—Examination by Dr Wyllie. Chest, right side, 18|; left, 16—together, 34|; left side somewhat shrunken. Anterior wall flattened, and movement very defective on left side. Per- cussion moderately resonant over whole left side, least so over base near wound. The note is nowhere quite so full as the normal per- cussion note of the right side. Bell sound beautifully present over whole side, except in the scapular region, where thickness of the parieties probably interferes with it. With wound closed there is absolute silence over whole left side on auscultation ; but if air is allowed to enter at the wound it produces a sound which, on auscultation of any part of the side, is heard as a loud ringing amphoric breathing. The right side is normal, except that the breathing sounds are puerile. Dec. 14:th, 1883.—Carbolic gauze changed to boracic lint, as former was irritating the skin. From this period, eight months after opening, up till March 1884, no record was made in the case book. By the latter date the use of the spray and antiseptic pre- cautions had been discontinued on account of the discharge having become putrid. At this period the dressings were of carbolic or salicylic wool changed almost daily. Sometimes as much as §xx. would come away in twenty-four hours. After this the patient began to lose ground progressively and perceptibly. On 30th May, 1884, an operation was performed to promote fall- ing in of the chest wall, and, if possible, obliteration of the exten- sive suppurating cavity. About an inch and a half was removed