Volume 1

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

  • Isaac Burney Yeo
Date:
1893
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 King’s College London. The original may be consulted at King’s College London.

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    their odour and aspect; these forms I’equire not only aseptic ])leurotomy, but also antiseptic irrigations. Finally, there is the tubercular variety, charac- terised by the presence of Koch’s bacillus. This form of pus is not easily identified, especially as it may also contain pyogenic micro-organisms, and a search for the tubercle bacillus is more often unsuccessful than successful. Are there any signs or symptoms by which we can determine that a pleuritic exudation is purulent 1 The physical signs are the same as when the effusion is sero fibrinous, but it is commonly stated as a mark of distinction that in cases of empyema there is cedema of the wall of the chest; this, how- ever, is certainly as often absent as present in such cases. Greater intensity and longer duration of pain are also said to distinguish purulent and tubercular from serous effusions. Better and more reliable evidence is the con- tinuance of fever, which assumes a hectic type. When the subject of an effusion into one or other pleural cavity continues to present the symptoms of a certain type of fever;—a temperature, with considerable diurnal fluctuations, rising in the evening and falling towards the morning, together with occasional shiver- ings and sweatings, a hectic flush on the cheeks, or an unhealthy muddy complexion, with loss of appetite, emaciation, etc., in such a case we may justly suspect that the effusion is purulent. If any doubt remains in our minds as to the nature of the effusion, it can be readily removed by a simple exploratory puncture by means of a hypodermic syringe, as already ex- plained. This simple and almost painless means of establishing our diagnosis should always be employed. It is as well to make the exploratory puncture, unless there should be any reason to the contrary, in the same spot as will be afterwards selected for the radical operation should this be ultimately required.