On the pathology of one form of encysted empyema / by Edward Latham Ormerod.

  • Edward Ormerod
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: On the pathology of one form of encysted empyema / by Edward Latham Ormerod. 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.

    22/28 page 20
    ing that, by decisive treatment, the disease might yet be subdued. b’ree incisions, therefore, were made by Mr. Stanley through the whole thick- ness of the lip, on each side of the nose, and into the substance of the cheek, over the myrtiform depression; from the latter wound thick, pultaceous matter issued. The incisions into the lip divided both superior coronary arteries, and they bled so freely, that it was necessary to secure them by ligature. The man lost twenty-five ounces of blood in this way. He was put on milk diet, and ordered a saline draught every four hours. Pulv. ipec. CO gr. x. o. n. A bread and water poultice to the face. 18th.—The tension and swelling of the upper lip, and the inflammation in the vicinity, have diminished. The cellular tissue exposed by the incisions appears infiltrated with punctiform deposits of us, and in a state of mortification; there as, however, been very little discharge from the wounds. But although in the lip the inflammation is less virulent, else- wnere it has extended on all sides. The left eyelids, the left side of the neck, and the right cheek, are affected and largely swollen ; the lower lip is in a similar state. The bright redness which twelve hours before characterised the inflammation, has been replaced by a livid, dusky discoloration. Pulse 120, much feebler. The skin is hot and wet with perspira- tion. The tongue cannot be seen, but it feels moist. Bowels relieved scantily since admission. The blood which was collected from the incisions made yesterday has formed a soft florid coagulum, which adheres to the sides of the vessel, and from which a small quantity of serum has separated. The urine is copious in quantity, neutral, and exhibits no crystals of oxalate of lime or other abnormal appearances when inspected by the microscope. Mr. Stanley, on seeing the patient, made small punctures in several parts of the cheek, which bled, but discharged no pus. In the evening, brandy and water, with wine and beef-tea, were ordered to be given alternately at intervals, and ammon. sesquicarb. gr. iij. were added to each saline draught. 19th.—He has slept little, and is evi- dently worse. The whole of the face and the left side of the neck are extremely swollen, and in a high state of inflam- mation. Pie complains, moreover, of sharp, stabbing pain in the chest, but no pleural friction sound can be detected] on either side. Pulse 152, sharp and] powerless. Skin hot and freely perspir-1 ing. Takes all his nourishment. j An incision was made into the lower ■ lip, from which a small quantity of pus ; issued. Ordered an enema of broth and ' arrowroot every four hours. Ammon. ; sesq. gr. iij., liq. cinch. 5ss., quartd i quaq. hora. Opiates at bedtime. Wine,: brandy, and beef-tea ad libitum. 20th.—Passed a wretched night, and was delirious. Is now sinking. Com- plains still of pain in the chest. Takes his nourishment freely by the mouth, but the enemata cannot be administered. Continue medicines and stimuli. 21st.—Delirious throughout the night. The face and neck are so tense and swollen that he can scarcely open his eyes. Pulse scarcely perceptible. Has not made any complaint of pain since yesterday, but is frequently seen to rub his side. Died at 5 a.m. on the 22nd. Post-mortem Examination Sixteen Hours after Death, Weather Warm.— No cadaveric rigidity. The swelling of the diseased parts had much subsided, and, on dividing an indurated spot, cel- lular tissue in a solid, white, and brawny condition was exposed. Pleurisy had existed almost to an equal extent on each side of the chest, the layers of serous membrane being united by opaque fibrinous effusion of recent formation, which was distributed late- rally and posteriorly in a tolerably uni- form manner. At the apex of the right lung, bands of lymph of older forma- tion existed. Nearly half an ounce of pus was found confined in a sort of sac formed between the left mediastinal pleura and the pericardium. Deposits of pus, varying in size from a bean to a millet seed, and placed in the midst of a patch of darkly congested paren- chyma, were disseminated through the structure of both lungs, apparently with- out regard to situation. The heart was healthy. Nothing abnormal was discovered in the peritoneum or abdominal organs. The internal jugular veins were free from disease. The blood, however, which flowed from the heart and great vessels was fluid and grumous, nor did it coagulate on exposure to the air. For the particulars of tliis interesting case I am indebted to my friend Mr. Hutchinson. The first and last of these cases are undoubtedly the worst of the series.
    digitised image 1
    digitised image 2
    digitised image 3