24 introduced into the pleural cavity, the object being to remove pus and fibrinous clots and especially the adhesions on the visceral pleura which would cripple lung expansion. I 3. After operation, daily aspiration of the fluid, put into the chest, with an aspirating syringe between the lips of the OXFORD MEDICAL SOCIETY. wound. This was quite painless. The fluid used to fill up the pleural cavity was either a 2 per cent. suspension of I iodoform in paraffin or more frequently flavine. Daily TREATMENT OF EMPYEMA. AT a meeting of this Society held last month at the bacteriological examination of the aspirated fluid was carried out until the fluid became sterile, when the aspiraRadcliffe Infirmary, the President, Dr. E. MALLAM, tion could be stopped. in the Mr. F. J. HATHAwAY (Windsor) chair, being Mr. Hathaway cited his own cases, nine since 1917 ; read a on this He
paper subject. began by pointing 11 cases lately done by Mr. P. H. Mitchiner at the out that the treatment of empyema-namely, incision Middlesex Hospital: and the better results claimed by and drainage by a tube--had not changed for the last Mr. R. T. Timberg at the Physico-therapeutic Depart100 years. He hoped that soon the open drainage ment of St. Thomas’s Hospital, as regards early lung of a chest with a sucking wound would be looked on expansion and freedom from scoliosis. He also2 as a surgical abomination. The post-war surgeon was Dr. J. A. Nixon and Mr. J. A. Blake, quoted not satisfied with the eradication of disease or pus of Newpapers byboth of whom advocated immediate York, alone, but put before himself a higher ideal, namely, closure in suitable cases. Dr. Nixon, in fact, had stated restoration of function, provided he ran no risk of belief that the time would shortly come when septicaemia. In the case of the knee-joint, peritoneum, open drainage of the chest would be looked on as a and pleura immediate closure of wounds had been surgical abomination. more than justified by restoration of function. In conclusion, Mr. Hathaway claimed that the As regards empyemata, Mr. Hathaway pointed out immediate closure of empyemata was that the structure of the pleura was peculiar in that now established, andpneumococcal that if the technique of a rigid thorax was associated with a collapsible early and complete operation were carried out the lung ; in the treatment of empyema with collapsed mutilating operation of Estlander would no longer be lung, it was therefore essential that the lung should necessary later. Convalescence would be shortened and be encouraged to expand as fully and as early as the physico-therapeutic results would be much better possible, for it was not until the lung fully expanded than they ever were with the use of a drainage-tube. full and that pleural suppuration would end. This ZMSCMSSMW. early re-expansion of the lung could only be produced In the which followed Dr. W. COLLIER discussion did immediate because this method closure, away by with the two great hindrances to lung expansion- spoke of the value of washing out the pleural cavity namely, the effects of atmospheric pressure and in cases which were not improving with ordinary drainage. Mr. H. A. B. WHITELOCKE emphasised the secondary infection. After quoting his own experience in gunshot importance of the respiratory diaphragmatic movewounds of the chest as surgeon to a casualty clearing ments in thoracic as well as in peritoneal drainage. station, he briefly reviewed the history of such wounds, Dr. A. G. GIBSON, Dr. W. STOBIE, and the PRESIDENT pointing out that even in the thirteenth century ’, also took part. Henri de Nondeville immediately closed the chest in order to avoid a " sucking wound." With the era ’, NORTH OF ENGLAND OBSTETRICAL of gunshot wounds proper, Felix Wurtz, in 1563, ’, AND GYNECOLOGICAL SOCIETY. recommended that chest wounds should be closed, as also did Guthrie and Baron Larrey in the nineHEART DISEASE IN PREGNANCY. teenth century. During the American Civil War, ’, the Franco-Prussian War, and the South African War I A MEETING of this Society was held at Manchester there was no improvement till after the first year of on Dec. 15th, 1922, with Mr. HAROLD CLIFFORD, the the late war, when the era of immediate excision of President, in the chair. gunshot wounds, introduced by Sir Henry Gray, of Mr. A. LEYLAND ROBINSON (Liverpool) read a paper Aberdeen, led the way for the immediate closure of on Heart Disease in Pregnancy and said that the wounds of the chest, abdomen, and joints. conclusions formed by Angus Macdonald in 1878 were As an important point bearing on the treatment in the main surprisingly applicable at the present time, of empyemata Mr. Hathaway described the crippling although some modifications had to be made in view effects on the lung of adhesions, even in a simple of the results of recent cardiological research. The hsemothorax. Mr. James Berry had laid down as latter had shown that cardiac murmurs did not an axiom that " a good surgeon is one who knows necessarily indicate serious disease and that many when to use a drainage-tube and when to remove it." systolio bruits were innocent if not actually physioMr. Hathaway went further in saying " a good logical. The myogenic theory of heart conductivity surgeon is one who realises that restoration of function had been demonstrated and a rational explanation is more important than the use or abuse of a drainage- provided for many types of formerly obscure cardiac tube." The historical treatment of empyema by irregularity. The discovery of auricular fibrillation Hippocrates, Galen, and Lister was then outlined by had brought to light an important mechanism in the the speaker, it being pointed out that Prof. Schede, production of heart failure. Prognosis was now deterof Hamburg, was the first to insist on the necessity mined by the efficiency of the heart muscle and its for the whole hand to be introduced into the pleural capacity for work. A pregnant woman with heart disease was primarily a heart case, but the influence cavity for the removal of clots and adhesions. Mr. Hathaway then dealt with the method of of pregnancy on cardiac disease and the special immediate closure of pneumococcal empyemata. dangers of labour formed a problem of great importance Early and complete restoration of lung function to the obstetrician. could only be satisfactorily accomplished by complete Pregnancy affected the heart and circulation in operation-i.e., by freeing the pleura of all adhesions. several ways : (1) An increased output of blood was The three most important points in the technique of demanded by the growing tissues (uterus, breasts) and operation were :by the placental circulation ; (2) the uterine tumour 1. Bacteriological examination of pus after aspiration. produced certain mechanical effects by simple pressure He did not advocate the immediate closure in any but on the base of the lungs and on the heart itself which pneumococcal cases. In a mixed staphylococcal and was dislocated upwards and rotated to the left; as pneumococcal infection, or in pure staphylococcal or pure a result the pulmonary circulation was and streptococcal cases, he advocated the use of a " passage- the right heart embarrassed. Pregnancy,impeded thereforetube," also called a rubber " dam," with closure of greater and particular labour with its severe muscular part of wound or use of Carrel-Dakin treatment.
2. Sufficiently large incision and resection of one, or section of two, ribs in order to allow the whole hand to be
1 Bristol Med.-Chir. Journal, 1921. 2 Annals of Surgery, April, 1922.