Purulent pericarditis following pneumonia : pericardotomy; drainage; subsequent empyema; operation followed by erysipelas and axillary abscess; recovery / by F.C. Shattuck and Charles B. Porter.

  • Shattuck, Frederick Cheever, 1847-1929.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Purulent pericarditis following pneumonia : pericardotomy; drainage; subsequent empyema; operation followed by erysipelas and axillary abscess; recovery / by F.C. Shattuck and Charles B. Porter. 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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    November 6th. For the first time signs of notable pericardial effusion were detected, the heart sounds being faint and dulness extending half an inch to the left of the left nipple. November 9th. Signs indicate a diminution in the amount of pericardial effusion. Fine crackling rales in left axilla. November 14th. Pericardial effusion has increased again. Dulness one and one-half to two iuches be- yond left nipple. November 18th. Nausea and vomiting rendered rectal feeding necessary. Paradoxical pulse. W hite count 12,950. November 22d. Paradoxical pulse very marked. Condition critical. On consultation with Dr. E. G. Cutler, the pericardium was aspirated in the fifth in- tercostal space, about one and one-half inches to the left of the left nipple, and 16 ounces of sero-purulent fluid were removed — specific gravity 1.021, albumin one-fourth per cent., cultures show pneumococci. Ihe pulse and stomach showed marked improvement after the aspiration. The reason for tapping in the above place will be set forth in a paper soon to be published. November 23d. Pulse irregular and weak ; tempera- ture steadily rising the last few days ; respiration ir- regular, with a suggestion of the Cheyue-Stokes type ; dyspnea in irregular attacks ; slightly delirious. November 24th. The pericardial effusion was again fully as large as before the aspiration, and it was evident that nothing but incision and free dis- charge of the sac could save the patient.; and, upon consultation with Dr. C. B. Porter, operation was de- cided upon and immediately performed. At the consultation it was decided to approach the pericardium at the point where aspiration had previously been done. A curved incision was made,