Pleurisy : including empyema and bronchiectatic conditions / by Alex. James.

Date:
1911
Catalogue details

Licence: In copyright

Credit: Pleurisy : including empyema and bronchiectatic conditions / by Alex. James. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    will be found thickened and adherent to the underlying fibrosed lung. The wound is then packed, and the patient sent back to bed. The advantage of this procedure is that on subsequent days, not only can we explore a very much larger area of pleura and lung, but that this can be done with comparatively little pain to the patient, as the pleura and lung are relatively insensitive. In making these subsequent explorations it will be found best, I believe, for the patient to be sitting up in bed. Instead of the ordinary sharp exploring needle, one of like size but made with a probe-like point and a side opening will often be found advantageous. It can easily be pushed through the lung tissue in all directions, and whilst it can readily reveal loculated empyemas, or bronchiectatic tubes, there is less likelihood of its causing injury to large blood-vessels at the root of the lung or to diaphragm at the base, than there would be when manipulating in these neighbourhoods with a sharp needle. When the pus is struck, a larger communication with it is made by a probe-pointed forceps, and through this the drainage-tube is then easily enough introduced. In cases where the empyema has opened, not into a bronchial tube, but through the chest-wall, the finding of the pus is usually not very difficult. As has been explained at p. 143, whilst the point is usually about the fourth or fifth spaces anteriorly, the empyema cavity is usually about the lower lobe posteriorly. There or thereabouts, therefore, we must look for it, and drain it when found. From what has already been stated as regards empyemas opening through the chest-wall, it must be evident that except in very rare instances, any attempts to drain them through their own openings would be hopeless. 3. Difficulties arising from the fact that the empyema, although suspected, looked for, and found on exploration, yet cannot be found on operation. Cases in which pus has been readily enough found by the