Case of chronic empyema treated successfully by paracentesis / by A. Peddie.

  • Peddie Alexander, 1810-1907.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: Case of chronic empyema treated successfully by paracentesis / by A. Peddie. Source: Wellcome Collection.

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

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    pitations. 72g were now withdrawn—the pleural sac being quite emptied; and he returned home on the following day. Paracentesis was on this occa- sion performed in the seventh intercostal space, in the most lateral part of the chest; and the pus drawn off was observed to be browner than for- merly. From this period up to the 4th of January last, I performed paracentesis on him four different times, draining off, on the 18th May 1848, 57§ ; on the 19th August 1848, 37g ; on the 2/th February 1849, G7g ; and the 4th January 1850, 26^. Thus he was operated on twelve different times, and in all 621^ of pus— equal to about 4 gallons—were taken from him. On each successive admission there was a manifest improvement of his general health and strength ; he could undergo a very considerable amount of fatigue, and on the six last occasions he returned home on the day following the tapping, without the slightest in- convenience or injury. The changes, too, in the configuration of the chest, more especially in the disappearance of the infra-clavicular fulness, were very marked; and when last seen, the intercostal spaces had much the same aspect as those of the opposite side ; and there was now some degree of movement of the side, during respiratory efforts, very different from its previously paralysed condition. More healthy respiration, also, was heard anteriorly, as low as the edge of the pectoral muscle, and also along the back near the spine. The heart now lay close to the sternum on the right side, and its impulse and sounds were perfectly normal. In the three last tappings I found that considerable force was necessary to introduce the trocar, owing, apparently, to the thickness and hardness of the pleura. This was particularly the case in the last operation ; and, although the canula of the trocar measured two and a-half inches in length, it seemed short enough for the depth of parts to penetrate. I may remark, also, that the fluid drawn off, although secreted in greatly increased quantity from November 1846 to September 1847—at which time it was going on at the rate of 56§ per month, from that period until the 4th January last it came gradually down in quantity until it had arrived at a ratio of little more than 2§ per month. It is interesting, also, to remark, that while the fluid was sero-purulent at first, and afterwards became pure pus, that at the last tapping a considerable amount of serum separated from the pus. This change, viewed in relation to the progressive improvement of Neilson's health in all respects, made me feel confident that a cure would soon be com- plete ; and, accordingly, I am glad to report that, in a statement which 1 had from him a few days since, he says that he considers himself quite recovered from the affection ; that he has felt so strong and well since he was last under treatment, that he recently entered into the bands of wedlock ; and is convinced that no farther operative interference will be necessary. He states that he is now capable for any ordinary exertion, can lie on either side without oppression of breathing; and does not consider that there is any material change in the con- figuration of the chest—unless it be a slight depression of the shoulder, and tendency to stoop, which, however, he states was the case before the inflamma- tion occurred. Of course, when a cure in this case is said to be complete, I admit that there is a lung, of which, perhaps, less than one-third only is fitted to perform any part in the function of respiration ; that there is an enormously thickened pleura, with strong adhesions connected therewith; and that there is a dislocation of the heart from its own compartment of the thorax, to which it can never return. Notwithstanding all this, I regard Neilson's case as satis- factorily cured, seeing that the functions of respiration and circulation are now carried on compatibly with existence; that the strength is re-established, and fully adequate for the duties of his calling ; and that, instead of feeling life as a burden, he is now in a condition, and is seeking, to enjoy it. The above case has been thus minutely detailed, as its interest and value appear to me to depend on its being so. It differs widely