Empyema and its allies, considered historically / by Charles J. MacAlister.

  • MacAlister, Charles John.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Empyema and its allies, considered historically / by Charles J. MacAlister. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    seem to have attributed the greatest danger to the too speedy evacuation of the fluid, whether serous or purulent,13 which they supposed—as pointed out by Galen—to cause a fatal loss of the animal and vital spirits.14 The operation, as already remarked, consisted either in incision with the knife or cautery, and was performed not only in cases where the pus had become partly evacuated through the lung, but also in cases where no such communication existed. There is a most interesting account of a method of confirming the presence of the pus in the chest in the Be Morbis,15 which directs that if the patient neither expectorates nor has the ordinary signs in the side, he is to be placed in a chair and shaken by the shoulders (his hands being held by assistants) in order to ascertain the situation of the pus by the splashing sound; and if this test failed, yet they were not to be deceived, but were to know that the thorax was full of pus by the difficulty of breathing, the swelling of the feet, and the cough; then, in order to ascertain which pleural cavity contained the pus, the chest was surrounded with a nakpin which had been dipped in hot water containing vermilion (Bubrica liquicla), thoroughly ground, and whichever part of this dried first indicated the position in which the incision with knife or cautery was to be made. It may be well to mention here that in the 2nd book of the Be Morbis it is recommended that the opening be made in the side which is most swollen and most painful, low down rather than in front, i.e., with the patient on his back, in order that the pus may escape more easily, a remark which proves the antiquity of the surgical principle of making an incision for drainage at the most dependent part; and another most interesting historical point is the observation that when the pus was thin (watery) a pewter drainage-tube was to be introduced, which was gradually shortened to allow the wound to heal. When the knife was used, in one book of the Be Morbis (iii.), it is stated that before making the incision the skin was marked; but elsewhere it is simply enjoined that an incision was to be made into the skin between the ribs with a knife, and then the subjacent parts were to be perforated with a pointed knife, guarded by having a piece of rag so wound round