Empyema : an excerpt from the Medical Department of the United States Army in the World War / by Edward K. Dunham.

  • Dunham, Edward K. (Edward Kellogg), 1860-1922.
Date:
1924
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Licence: In copyright

Credit: Empyema : an excerpt from the Medical Department of the United States Army in the World War / by Edward K. Dunham. Source: Wellcome Collection.

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    Case 36.—G. M. A., aged 23 years. March 23, 1921, developed pneumonia; complicated by empyema, left pleural cavity, hemolytic streptococcus type, May 1, 1921. Aspirated three times. May 9, 1921, operation; thoracotomy; resection of 10 cm. sixth, rib, anterior axillary line, with the institution of drainage, and irrigation with Dakin’s solution daily. June 9,1921, admitted to empyema service, Walter Reed General Hospital. Condition on admission: Ambulatory case; poorly nourished; anemic; showing some loss in weight; marked shortness of breath. Present weight, 111 pounds. Examination of chest revealed sinus discharging pus sixth interspace, anterior axillary line, left chest; pleurobronchial fistula present; and a cavity formation with a capacity of 200 c. c. Radiographs showed partial collapse of left lung with some thickening of the parietal pluera, left lateral chest, from the second to ninth rib, and a cavity formation running transeversely across the chest from the nipple line anterior to the posterior scapular line, the lower aspect of it being on a level with the seventh rib; heart slightly displaced to the right and posteriorly. Clinical laboratory examination: Wassermann negative: sputum negative for tubercle bacilli; white blood count, 19,300; red blood count, 4,720,000; urine negative; culture from cavity showed hemolytic streptococcus and staphylococcus aureus. Blood pressure: Systolic, 115; diastolic, 82; pulse pressure, 33. Vital capacity reading not taken. June 30, 1921, operation; resection of 20 cm. of seventh rib, posterior axillary line, left chest; cavity laid wide open and lung freed about fistula and allowed to retract, thus mobilizing site of fistula; skin fixed over muscles which were severed to prevent retraction; cavity left wide open for active dakinization. July 25, 1921, lung well expanded; fistula closed and wound well granu¬ lated, cavity obliterated, se\en consecutive sterile cultures having been obtained, cavity was allowed to close. September 15, 1921, patient entirely healed and feeling well: general condition excellent, weight, 135 pounds. Vital capacity reading, 3,200 c. c. Discharged from the service and hospital as cured December 8, 1921. Factors to be combated in this case were hemolytic streptococcus present* pleurobronchial fistula present; drainage not dependent. Case 37.—O. C., age 22 years. December 20, 1919, developed influenza; complicated by empyema, right pleural cavity, hemolytic streptococcus type, January 25, 1920. Aspirated twice. February 3, 1920, thoracotomy; resection of 5 cm. of the sixth rib anterior axillary line, right chest. March 12, 1920, operation; incision and drainage. May 15, 1920, chest allowed to close. June 28, 1920, operation; incision and the institution of drainage. Chest was allowed to close and was reopened six times. October 2, 1920, admitted to the empyema service, Walter Reed General Hospital. Condition on admission: Ambulatory; patient anemic; weight, 149 pounds (normal weight, 160 pounds). Examination of chest revealed sinus discharging pus, anterior axillary line, sixth interspace, right chest. Radiographs showed partial collapse of right lung, with marked thicken¬ ing of the parietal pleura, and a cavity triangular in outline and about 6 to 8 cm. deep, extending upward; heart, aorta and trachea displaced to the right. Capacity of cavity, 150 c. c. Clinical laboratory examination: Wassermann negative; sputum negative for tubercle bacilli; white blood count, 8,500; red blood count, 4,380,000; urine negative; culture from cavity showed heavy growth of hemolytic streptococci. Blood pressure: Systolic, 115; diastolic, 76; pulse pressure, 39. Vital capacity reading, 2,800 c. c. October 21, 1920, resection of 20 cm. of sixth, seventh, and eighth ribs; posterior axillary line cavity laid wide open and prepared for active dakinization. December 1, 1920, secondary closure with plastic muscle flap using a portion of the latissimus dorsi muscle; superficial, severed muscles brought in apposition and skin sutured. March 20, 1921, patient entirely healed; general condi¬ tion excellent; weight on admission, 149 pounds; weight on discharge, 160 pounds. Vital capacity reading, 3,400 c. c. Patient completely cured and discharged May 26, 1921. Factors to be combated in this case were hemolytic streptococcus present; primary drainage was not dependent; cavity led directly into mediastinum. Case 38.—A. M., age 27, October 23, 1918, developed influenza, followed by pneumonia October 27, 1918, and complicated by empyema, left pleural cavity, hemolytic streptococcus tyoe, November 2,1918. There were four operations, prior to admission to Walter Reed General Hospital’ with partial resection eighth and ninth ribs, left side.