Volume 1

A manual of medical treatment, or, Clinical therapeutics / by I. Burney Yeo.

Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: A manual of medical treatment, or, Clinical therapeutics / by I. Burney Yeo. 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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    [Pan in. inserting the index finger into tlie opening. If the lung expands promptly, its lower margin can often be seen through the opening towards tlie end of tlie evacuation. The more the lung expands the less the amount of air rushing through the opening into tlie chest. In order to prevent synco|je upon the sudden diminution of intrathoracic pressure during tlie evacua- tion of the pus, I have been in the habit of administer- ing, before the anossthetic is given, -^-^ of a grain of atropine with |- of a grain of morphia hypoderuiically, witli an alcoholic stimulant by the mouth or rectum. If, as is often the case, the pleura is lined with thick partially detached membranes, these should be removed ■with a dull curette, as they are invariably infected witli pus microbes, and tlieir presence in the pleural cavity would prolong infection and retard recovery. It used to be a common practice to wash out tlie pleura aftei* pleurotoray, but far greater circumspection is now observed with regard to this practice, which has been sliown to be not without danger. It is super- fluous in the absence of foetor and of saprogenic organ- isms, and it is useless when there exists a bronchial fistula. It should be reserved for the ])utrid forms of empyema, and those in which extensive false mem- branes are found adlierent to the pleural sinfaces. The following fluids have been suggested, besides those just mentioned, as quite harmless for tliis pur])0se :— Boiled water filtered with a teaspoonful of common salt to each pint; Thiersch's solution of two parts of salicylic acid, and 12 of boric to 1,000 of steri- lised water ; Labarraque's solution of chlorinated soda, 1 in 15 or 20 of water; a 10 to 50 per cent, solution of peroxide of hydrogen ; a solution of acetate of alumina, 1 to 5 per cent. Care must be taken that the solution is of the same temperature as the body, and the irrigation should always be made with a steady siphon stream, and with a free outlet. As we have already said, great attention must he paid to secvxring the most perfect antisejDsis in dressing the wound, and this must be maintained throughout