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TREATMENT OF EMPYEMA BY PERFLATION.
226 taneous flow of pus has ceased, and the same process is to be repeated at each dressing.
Correspondence. " Audi alteram
partem."
TREATMENT OF EMPYEMA BY PERFLATION. To the Editor
of THE LANCET.
SiR,-Permit me, through your widely circulated columns, a trial by the profession of a simple method which I have employed with success in the treatment of empyema. My original case being meant for publication at some distant ’date, I am anxious meanwhile not to delay the wider applito invite
cations of a treatment which may prove useful to many, and which requires to be tested in a more extensive field than that of my own practice. Perflation (Anglice, " through blast "), as applied in - empyema, has the following objects:-(I) the avoidance of all fluid injections, and of the irritation which, as foreign substances, they cannot fail to excite; (2) the evacuation (in the absolute sense) of the pleura, a cavity seldom emptied by fluid injections. The accompanying diagram illustrates the mode of application sufficiently clearly to obviate the necessity for a lengthy description. It should be stated, however, that strict antiseptic precautions and dressings, and the employment of an efficient disinfecting spray are - essential parts of the treatment. The apparatus required is at hand in every hospital, or ccan be obtained at the shortest notice from any chemist. It
I
The principles underlying the method are the following: 1. Whereas fluids obey gravitation, air will diffuse into every nook and cranny. 2. Whilst an injected fluid stream strikes few spots only, leaving other parts uninfluenced, the current of air will transmit in every direction even fractions of its own pressure. 3. Whilst water merely dilutes fluids and suspends light solids, any fluid or detached solid will sink in air. It follows that if the patient be so placed that the wound strictly coincides with the most dependent spot of the cavity to be drained, any fluid or solid will either escape at the opening or plug it. If a plug be thus formed whilst the bellows are worked continuously, pressure will rise behind the plug and probably expel it. Plugs of this kind are habitually furnished by fragments of necrosed lung, by blood-clots, and by purulent false membranes. I possess evidence of the efficacy of the air-blast in detaching false membranes which had resisted a long course of irrigation; to their presence is probably due the protracted suppuration of many empyemas. It is unnecessary for me to encroach upon your valuable space with remarks on the merits of the dry treatment" of suppurating surfaces, or on the surgical value of local future discussion. ventilation. These topics are reserved I would only add that the favourable results I have obtained in empyema lead me to expect that deep-seated abscesses or suppurating cavities beyond the reach of the finger may, without danger, and with probable benefit, be submitted to the treatment I have sketched. 1 shall watch for the verdict of surgeons who may be tempted to put the method to a practical test, and I shall be happy to furnish any further explanations to those who may honour me with I remain, Sir, your humble servant, their inquiries. WM. EWART. Curzon-street, Mayfair, July 20th, 1886. P.S.-The average duration of each perflation has been ten minutes ; on one occasion it exceeded three-quarters of I have not hitherto observed any carboluria, an hour. neither has there been the slightest complaint of pain, discomfort, or internal draught. In the intervals between the dressings a stout drainage-tube should provide for the continued patency of the wound, and the opening should be sealed by an air-tight dressing of medicated wool, which will for the time convert the chest into a closed cavity and afford an opportunity for the expansion of the lung.
for
THE VITALITY OF PATHOGENIC MICROORGANISMS IN WATER. To the Editor of THE LANCET.
SiR,—Messrs. Crookes, Odling, and Tidy having recently published the results of some experiments which they have made
’consists of (1) Richardson’sbellows; (2) indiarubber tubing; (3) a bottle about 8 in. high, to contain, to the depth of 1- in., (4) a solution of carbolic acid, 1 in 10; (5) a good cork perforated by two tubes-the one, barely projecting within the bottle, to be connected with the chest, the other of sufficient length to dip not more than 1 in. below the surface of the solution for connexion with the bellows. Potain’s cork here depicted can readily be fitted fcr the purpose in view, and will be found most convenient; the
tap B is superfluous ; tap A may be used, as originally suggested to me by Mr. R. F. Benham, whenever it is desired to raise the pressure within the bottle, although in the absence of a tap an ordinary clip or pressure from the finger will answer as well. The treatment is applicable at any stage of a suppurating
empyema. Where two openings have been made, one is utilised for the entrance of air; the other (lower) opening In such a case reflux of air by the side of serves as exit. the tube inserted into the upper opening must be prevented by a broad flange attached to the tube, or by the firm application around the latter of a moistened pad. It is, however, an advantage of my method that in any ordinary case A single good-sized a second opening is unnecessary. - opening will allow sufficient room for the air-supplying tube and also for the escape of the contents of the cavity. Once having grasped the principle of the procedure, each operator will be the best judge of the exact size of the incision required. The tube may be inserted (to a depth of several inches) and perflation begun as soon as the spon-
the vitality of the bacillus anthracis in London I should like to offer the following remarks :water, The behaviour of various pathogenic micro-organisms in water has, during the past three years, formed the subject of experiments by several authors, including Koch, Cornil and Babes, Nicati and Rietsch. Within the last two months no less than three papers bearing on this subject have been and published, two of them in Germany, by Drs. Meade Bolton respectively; whilst the third, by myself, on the " Multiplication of Micro-organisms," was communicated to the Royal Society at their meeting in June last. In this paper I have recorded a large number of experiments made both with the mixtures or organisms found in various natural waters, as well as with three well-characterised forms which are associated with disease-viz., Koch’s comma spirillum of Asiatic cholera, Finkler-Prior’s comma spirillum of European cholera, and the bacillus pyocyaneus which produces the greenish-blue colouring matter frequently present in abscesses. The methods of research which have been independently selected both by Wolffhugel, Meade Bolton, and myself are identical, and consist in the examination, by gelatine-plate cultivation, of water purposely impregnated with the organisms in question. This method is obviously the one which most recommends itself for the purpose, as it not only enables one to ascertain the presence or absence of the organisms, but also of quantitatively following their multiplication or reduction. I may mention that these three organisms present great differences in their behaviour under similar circumstances; thus the bacillus pyocyaneus is possessed on
Wolffhugel
Correspondence. " Audi alteram
partem."
TREATMENT OF EMPYEMA BY PERFLATION. To the Editor
of THE LANCET.
SiR,-Permit me, through your widely circulated columns, a trial by the profession of a simple method which I have employed with success in the treatment of empyema. My original case being meant for publication at some distant ’date, I am anxious meanwhile not to delay the wider applito invite
cations of a treatment which may prove useful to many, and which requires to be tested in a more extensive field than that of my own practice. Perflation (Anglice, " through blast "), as applied in - empyema, has the following objects:-(I) the avoidance of all fluid injections, and of the irritation which, as foreign substances, they cannot fail to excite; (2) the evacuation (in the absolute sense) of the pleura, a cavity seldom emptied by fluid injections. The accompanying diagram illustrates the mode of application sufficiently clearly to obviate the necessity for a lengthy description. It should be stated, however, that strict antiseptic precautions and dressings, and the employment of an efficient disinfecting spray are - essential parts of the treatment. The apparatus required is at hand in every hospital, or ccan be obtained at the shortest notice from any chemist. It
I
The principles underlying the method are the following: 1. Whereas fluids obey gravitation, air will diffuse into every nook and cranny. 2. Whilst an injected fluid stream strikes few spots only, leaving other parts uninfluenced, the current of air will transmit in every direction even fractions of its own pressure. 3. Whilst water merely dilutes fluids and suspends light solids, any fluid or detached solid will sink in air. It follows that if the patient be so placed that the wound strictly coincides with the most dependent spot of the cavity to be drained, any fluid or solid will either escape at the opening or plug it. If a plug be thus formed whilst the bellows are worked continuously, pressure will rise behind the plug and probably expel it. Plugs of this kind are habitually furnished by fragments of necrosed lung, by blood-clots, and by purulent false membranes. I possess evidence of the efficacy of the air-blast in detaching false membranes which had resisted a long course of irrigation; to their presence is probably due the protracted suppuration of many empyemas. It is unnecessary for me to encroach upon your valuable space with remarks on the merits of the dry treatment" of suppurating surfaces, or on the surgical value of local future discussion. ventilation. These topics are reserved I would only add that the favourable results I have obtained in empyema lead me to expect that deep-seated abscesses or suppurating cavities beyond the reach of the finger may, without danger, and with probable benefit, be submitted to the treatment I have sketched. 1 shall watch for the verdict of surgeons who may be tempted to put the method to a practical test, and I shall be happy to furnish any further explanations to those who may honour me with I remain, Sir, your humble servant, their inquiries. WM. EWART. Curzon-street, Mayfair, July 20th, 1886. P.S.-The average duration of each perflation has been ten minutes ; on one occasion it exceeded three-quarters of I have not hitherto observed any carboluria, an hour. neither has there been the slightest complaint of pain, discomfort, or internal draught. In the intervals between the dressings a stout drainage-tube should provide for the continued patency of the wound, and the opening should be sealed by an air-tight dressing of medicated wool, which will for the time convert the chest into a closed cavity and afford an opportunity for the expansion of the lung.
for
THE VITALITY OF PATHOGENIC MICROORGANISMS IN WATER. To the Editor of THE LANCET.
SiR,—Messrs. Crookes, Odling, and Tidy having recently published the results of some experiments which they have made
’consists of (1) Richardson’sbellows; (2) indiarubber tubing; (3) a bottle about 8 in. high, to contain, to the depth of 1- in., (4) a solution of carbolic acid, 1 in 10; (5) a good cork perforated by two tubes-the one, barely projecting within the bottle, to be connected with the chest, the other of sufficient length to dip not more than 1 in. below the surface of the solution for connexion with the bellows. Potain’s cork here depicted can readily be fitted fcr the purpose in view, and will be found most convenient; the
tap B is superfluous ; tap A may be used, as originally suggested to me by Mr. R. F. Benham, whenever it is desired to raise the pressure within the bottle, although in the absence of a tap an ordinary clip or pressure from the finger will answer as well. The treatment is applicable at any stage of a suppurating
empyema. Where two openings have been made, one is utilised for the entrance of air; the other (lower) opening In such a case reflux of air by the side of serves as exit. the tube inserted into the upper opening must be prevented by a broad flange attached to the tube, or by the firm application around the latter of a moistened pad. It is, however, an advantage of my method that in any ordinary case A single good-sized a second opening is unnecessary. - opening will allow sufficient room for the air-supplying tube and also for the escape of the contents of the cavity. Once having grasped the principle of the procedure, each operator will be the best judge of the exact size of the incision required. The tube may be inserted (to a depth of several inches) and perflation begun as soon as the spon-
the vitality of the bacillus anthracis in London I should like to offer the following remarks :water, The behaviour of various pathogenic micro-organisms in water has, during the past three years, formed the subject of experiments by several authors, including Koch, Cornil and Babes, Nicati and Rietsch. Within the last two months no less than three papers bearing on this subject have been and published, two of them in Germany, by Drs. Meade Bolton respectively; whilst the third, by myself, on the " Multiplication of Micro-organisms," was communicated to the Royal Society at their meeting in June last. In this paper I have recorded a large number of experiments made both with the mixtures or organisms found in various natural waters, as well as with three well-characterised forms which are associated with disease-viz., Koch’s comma spirillum of Asiatic cholera, Finkler-Prior’s comma spirillum of European cholera, and the bacillus pyocyaneus which produces the greenish-blue colouring matter frequently present in abscesses. The methods of research which have been independently selected both by Wolffhugel, Meade Bolton, and myself are identical, and consist in the examination, by gelatine-plate cultivation, of water purposely impregnated with the organisms in question. This method is obviously the one which most recommends itself for the purpose, as it not only enables one to ascertain the presence or absence of the organisms, but also of quantitatively following their multiplication or reduction. I may mention that these three organisms present great differences in their behaviour under similar circumstances; thus the bacillus pyocyaneus is possessed on
Wolffhugel