Treatment of pleurisy & empyema / by John E. Morgan.

  • Morgan, John Edward, 1829-1892.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Treatment of pleurisy & empyema / by John E. Morgan. 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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    tubing threaded through its upper extremity, was carried completely through the chest. The two ends of the tube, were then tied together, and the pleural sac daily washed out with a carbolic acid lotion In this case it was found necessary to make a double opening, with a view of finding free egress for the pus. Unless, however, the case be very chronic and the adhesions exceptionally firm, I prefer breaking down the bands of fibrin and liberating the pus by a single opening. This was a most tedious and protracted case, and clearly demonstrated the importance of keeping the plueral sac thoroughly clean, and not allowing pus to accumulate or stagnate in any portion of the chest. Over and over again, whenever the temperature rose, the interior of the pleural sac was carefully explored until the particular spot was discovered in which the pus was collected As soon as this was liberated by the catheter and the. source of irritation drawn off the temperature immediately fell. The case was instructive in other ways also, for whenever the temperature rose only two degrees, the patient lost weight, and was unable to take cod-liver oil, from which when the feverish symptons were absent, he invariably derived much benefit albumen also reappeared in the urine, while diarrhoea and sickness returned. For twelve months the chest was washed out every day. During this time the amount of fluid which the pleural sac was capable of containing was at stated times carefully measured. Immediately after the operation it held four pints and two ounces ; but in the course of seven months it did not admit more than eight ounces. In the early part of the treatment the chest was washed out with carbolic acid and water. After a time however when the progress of the case seemed slow, tincture of iodine, in the proportion of half a drachm to the ounce of water, was substituted. On other occasions, again, chloride of sodium, quinine, and permanganate of potash were used. The temperature of the lotion employed ranged from 92° to 98°. while the dressing was proceeding a Lister spray-producer was directed upon the thorax, and after the rinsing out of the cavity was completed the spray was directed along a catheter into the pleural sac. During the treatment, likewise, the patient daily inhaled compressed air from Seigel’s pneumatic apparatus. From the description I have given of this case it will be admitted that it was one of very great gravity. The remedial measures were perseveringly continued for eighteen months. The patient made an excellent recovery. This was one of three cases of empyema introduced by me to the notice of the Medical Society of Manchester in 1879. The patient then looked muscular and healthy. The difference between the two sides was comparatively insignificant. There was very little retraction. The chest was well developed and freely admitted air into the regions wjbfich at one time had been rudely perforated by the trocar and cann\ffa. The temperature was normal, the pulse regular and even, and the vital capacity had increased from 70 to