E. Rochelt (Wiener med. Presse, No. 32 and 38, 1887). The expansion of
the lung is greatly impeded after the usual operation for empyema by
incision, by the free entrance of air in the pleural cavity. Mader,
Subbolik and Immerman devised means for preventing this. R. operates by
first resecting a rib, leaving the periosteum intact, and subsequently
opening the pleural cavity by means of a trocar and canula. A drainage
tube accurately filling the latter is now introduced, through which a
disinfecting fluid is injected and its outer opening closed by means of
a spring clamp. The tube is connected to an aspirating bottle, into
which the pus is discharged. The tube is again clamped, and the bottle
into which the pus has been aspirated removed, being replaced by another
containing a sublimate solution, 1 to 500. Removal of the clamp and
raising and lowering the bottle thoroughly irrigates the pleural cavity.
This being accomplished, the patient holding his breath in expiration,
and the clamp again applied, the irrigating bottle is removed, and a
short hard rubber tube connected to the outer end of the drainage tube.
This hard rubber tube has a soft rubber diaphragm which acts as a check
valve, effectually preventing the ingress of air during inspiration, but
in no wise interfering with the egress of fluid from the pleural cavity
during expiration, fits of coughing, etc. For purposes of further
irrigation the short rubber tube containing the valve may be removed
after guarding against the entrance of air by clamping the drainage tube
beyond, and the washing bottle reapplied. During the intervals of
irrigation, absorbent antiseptic dressing are kept applied.
The abstractor would suggest the application of this method,
particularly in recent cases and in children, without the previous
resection of a rib. The increased support afforded the canula by the
greater thickness of the thoracic walls would be a still greater
safeguard against the entrance of air into the pleural cavity. A certain
proportion of acute cases will recover without resection of a rib.