Report of a case of empyæma, with operation for closure of pleural cavity by removing portions of four ribs, with remarks / by A. G. Miller.

  • Miller, Alexander Gordon.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Report of a case of empyæma, with operation for closure of pleural cavity by removing portions of four ribs, with remarks / by A. G. Miller. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    especially sibilations present over whole side, but in no great abundance. Vocal resonance very distinct, but not louder than might be expected from emaciated condition of costal parieties. After this period discharge diminished considerably, and there was promise - of the wound closing, and the patient improved in ■ general health and spirits. Injections of various lotions were tried to hasten the closure of the cavity and approximation of its walls. Iodine caused some irritation and increased the discharge. Cor- rosive sublimate (1 to 2000) seemed to do well, but had to be dis- continued on account of its producing diarrhoea. Twice the wound was closed and sealed with collodion after careful washing out, but the discharge was merely dammed back, and had to be let out after a few days on account of the respiration being im- peded. The cavity which before the removal of the ribs contained many ounces of fluid, never could be made to retain more than 3 ounces of injection after the operation. For a week or two before his death the patient suffered from fits of unconsciousness, which afterwards were accompanied by convulsions, sometimes unilateral and sometimes bi-lateral. In Dr Wyllie's absence he was seen by Dr Muirhead, who pronounced them to be due to uraemia. Patient gradually sank and died on the 11th September 1884—one year and five months after the commencement of his illness. Post-mortem examination made on September 13th, 1884, by Dr Alex. Bruce, in the absence of Dr Bramwell. Chest.—Left side of the thorax below the level of the nipple is much contracted. The right side of the chest, at the level of the base of the xiphisternum and also that at the level of the second rib, measures 16| inches. The corresponding measurements on the left side are 14 inches and 14| inches. On the left side there is a sinus pointing between the 8th and 9th ribs, and another between the 9th and 10th ribs, also four linear cicatrices over the 4th, 5th, 6th, and 7th ribs,' 2^ inches long, crossing the anterior axillary line on the left side. Heart—ATpex found lying between the 3rd and 4th ribs 5 inches to the left of the middle line. In the left mammary line the upper border of the diaphrao-m extends up to the lower border of the 4th rib. ^ The left pleural cavity contains 7 ounces of cream-coloured not foetid, pus. The fluid occupies less than a fourth of the cavity. The right pleural cavity is partly obstructed by adhesions ilie left pleural cavity extended from the level of the lower border of the 4th rib upwards to the apex. This cavity com- municated by an aperture f of an inch in diameter with a smaller