Surgical lectures and essays / by A. Marmaduke Sheild.

  • Sheild, A. Marmaduke (Arthur Marmaduke)
Date:
[1904?]
Catalogue details

Licence: In copyright

Credit: Surgical lectures and essays / by A. Marmaduke Sheild. Source: Wellcome Collection.

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    sternum; the pus deluged the clothing and bed of the patient. He was obviously very ill and seemed in a pysemic state, and I determined to make a more free opening for escape of pus. He was given the A.C.E. mixture with great precautions, and the anaesthetic was not closely pushed because of the dyspnoea and general congestion of throat and fauces. I laid open all the sinuses near the upper part of the sternum, cut away their edges, and scraped out unhealthy granulations. An open- ing- large enough to admit the index finger Avas found close to the edge of the sternum, in the left first interspace. This led into the mediastinum. The back of the sternum was superficially carious, and it was obvious that the case was one of mediastinal abscess which had emerged from the chest beneath the pectoral muscle, and also through the first interspace, where spontaneous evacuation had occurred. The parts were tamponaded with iodoform gauze, and slowly but surely healed. The pus was very serous and watery and contained the pneumococcus in abundance. As might be expected, the subpectoral abscess again slowly filled, and it was opened and drained by Dr. Cooper. He informs me that the sinus still sometimes discharges, but that the man is able to follow his employment, being almost entirely relieved of his old respiratory distress. Later reports state that he is almost quite well. Sub- pectoral swellings are often difficult of diagnosis. Abscess in this situation is almost invariably due to necrosis of the ribs or sternum; seldom, if ever, does it really origi- nate in the mamma. Such abscesses, if opened, discharge indefinitely unless the necrosed bone can be removed. Other causes of suppuration in this locality are blows, and the discharge of an empyema or abscess of the lung. A few cases of soft sarcomatous growths are recorded as originating beneath the mamma, and obviously the similarity to abscess of these serious affections would be very close. So, gummatous formations may occur in this locality, but in the cases I have seen the tumour was