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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    1] sacs by false membranes, and these could not be sufficiently cleared out by the rinsings ; in consequence of this the pleural sac ichorised.” The experience I have had has convinced me that sufficient care is not taken to get rid of the pus thoroughly and completely. I have frequently seen patients treated after the orthodox fashion (a perforated tube being passed through the thorax along which the pus was expected to find a free outlet), apparently make a good recovery. The discharge gradually ceased, the wound closed, and the patient left the hospital nominally well. The cure, however, was not permanent; caseous degenerative changes occurred in the retained pus, tubercular disease was set up, and death supervened after a protracted illness. To prevent such accidents free egress must be found for the pus. In several cases in which the temperature rose rapidly and unex- pectedly during treatment the feverish symptons were attributed to the presence of pus, which it was impossible to liberate from within. Here a second or even a third opening was made in the thoracic wall, through which the peccant fluid was readily with- drawn. The situation for this outlet being determined by the thermometer. For where there are underlying purulent deposits there the temperature of the superimposed skin will be higher than over the remaining portions of the surface of the chest. In treating empyema we must never forget that certain pro- ducts of inflammation are destructive, and incapable of being organised. So long as they remain in the system they will inevit- ably prove a source of irritation. It should be our constant endeavour to assist in removing these destructive products of inflammation. The bands of fibrin we should also, as far as prac- ticable, break down as they are forming. They contribute largely to that unsightly retraction of the chest which is so frequent an attendant on protracted cases of empyema. It has been proved to demonstration that the fibrin takes no very active share in the organising process, It cripples the expansion of the Inng and binds it down to the ribs. Rindfleisch, in describing the inflam- mation of serous membranes in cases of pleurisy, observes :— ■‘We must divide the layer of exudation which lies loosely on the serous surface into two strata—an upper one, which consists of fibrin, and a deeper stratum of young connective tissue formed by a proliferation of the connective tissue of the serous membrane. Upon the surface of the serous membrane connective tissue corpuscles appear embedded in a clear matrix, containing mucin, together with which they make up the layer of embryonic tissue. From these cells and matrix the true ‘ plastic exudation ’ is really formed, and not, as used erroneously to be supposed, by the fibrin.” I propose, in the next place, to refer to two typical cases, which appear to me to illustrate the preceding remarks. In these cases the difficulties I have discussed were strikingly exemplified, still the results of treatment proved eminently satisfactory. The