The diagnosis of empyema may be made, but the outline of the area of dulness, the fact that there is no shifting dulness, and the greater resistance which is present in empyema nearly always clear up any difficulty promptly.
Pneumothorax and empyemafollow perforation into the pleural cavity.
Usually there are many adhesions and careful ray study may reveal one or more the breaking up of which will improve drainage to such an extent as to cure an empyema of long standing.
In a small proportion of the cases empyema followed; but I never saw this in any case that had neither been tapped nor opened, and I saw only one patient die from a chest wound uncomplicated by other injuries.
As to the cases of hæmothorax and empyema which needed drainage, all did well; but expansion of the lung was much less satisfactory than would have been expected, probably on account of especially firm adhesions.
During the whole campaign the single case of primaryempyema that I saw was the one recorded below, which deserves special mention as illustrating the disadvantage of extracting bullets on the field.
The second rise was accompanied by sweating, quickened pulse, and the probability of the development of an empyema had always to be considered.
The sinuses associated with empyema are prevented from healing by the rigidity of the chest wall, and will only close after an operation which admits of the cavity being obliterated.
In empyema he objects to caustics and prefers the knife.
For instance, forempyema he advises opening of the chest.
Bronchitis is mentioned in two of the cases already quoted, pneumonia in one case, pneumonia and empyema in one, and purulent mediastinitis in one, with three deaths in all.
This is the favourite operation in well-marked chronic empyema of the antrum.
When this does occur the abscess should be opened through an incision designed on the principle given later on for chronic empyema (see p.
If, however, the patient’s general condition be good, operation may be attempted as a last resource even although a pulmonary empyema or a one-sided cavernous sinus thrombosis already exists.
When three to six months have passed without any trace of secretion, the empyemamay be considered cured.
This undeniably is so, when the antral empyema is uncomplicated by suppuration in other cavities, but the operation is not free from risk if they are also infected.
In cases of chronic empyema of the maxillary sinus this operation is very successful.
Additional confirmation of the fact that Hippocrates was familiar with the phenomena of these diseases may be found in his dissertation on empyema and fevers.
The accident has usually been met with in alcoholics, and has proved fatal by setting up left-sided empyemaor cellulitis.
Asymmetry of the thorax, such as may follow on empyema with defective expansion of the lung, causes a lateral deviation of the dorsal spine with the convexity towards the normal side.
Through the medium of subphrenic abscess, or directly through adhesions between the stomach and the diaphragm, gastric ulcer may perforate into one of the pleural cavities (generally the left) and cause empyema or pneumo-pyothorax.
When the growth is upward through the lungs, the symptoms belonging to empyema or hydrothorax, with pulmonary abscess, ensue, and the termination is fatal after a protracted course.
The empyema thus induced may indeed be the principal lesion, as in the case of the late Gen.
In still other cases an extensive purulent accumulation may form in the pleural cavity, the lung is compressed, and all the phenomena of an empyema superadded to those of a hepatic abscess.
Hippocrates refers to a bellied scalpel in a well-known passage onempyema (ii.
Hippocrates in the famous passage on the surgical treatment of empyema (ii.
A tube on similar principles to the ascites cannula was employed in empyema (Hippocrates, ii.
Paul refers to it for opening the thorax inempyema (VI.
