The rules of aseptic and antiseptic surgery; a practical treatise for the use of students and the general practitioner . containmore or less of it. This can be easily ascertained by gentle pressure, whichwill cause a copious flow of pus. Frequent irrigation is a very imperfectsubstitute of proper drainage ; therefore, the making of a well-placed incis-ion should remedy the shortcoming. c. Empyema.—Infection of the pleura by pyogenic organisms, eitherthrough metastatic processes or by direct extension from the bronchi andlungs ; from without by injury, or from purulent affections of the vicinal
The rules of aseptic and antiseptic surgery; a practical treatise for the use of students and the general practitioner . containmore or less of it. This can be easily ascertained by gentle pressure, whichwill cause a copious flow of pus. Frequent irrigation is a very imperfectsubstitute of proper drainage ; therefore, the making of a well-placed incis-ion should remedy the shortcoming. c. Empyema.—Infection of the pleura by pyogenic organisms, eitherthrough metastatic processes or by direct extension from the bronchi andlungs ; from without by injury, or from purulent affections of the vicinalregions, as, for instance, perinephritic or liver abscess, leads to the forma-tion of empyema—that is, an accumulation of pus within the pleural diagnosis of the affection is based upon the fever, dyspnoea, the absenceof respiratory murmur, the dull percussion sound, rigidity of the affectedside of the thorax, flatness of the intercostal depressions, and more or lessmarked cedema of the integument over the site of the accumulation. Probatory ])iincture with a hypodermic needle will usually yield Fig. -Dressing for mammary abscess,or empyema. DIAGNOSIS AND TREATMENT OF PHLEGMON. 227 The proper treatment consists of timely incision, disinfection, and drain-age nnder antiseptic cauteh\3. Management of Recent Cases of Empyema.—The thorax of the ansesthe-tized patient is cleansed and disinfected, and an incision is made, from twoto three inches in length, in the eighth intercostal space, parallel with theribs, and a little back of the axillary line. The skin and muscles are grad-ually divided down to the pleura, which is then incised. The sudden gushof ])us is checked and moderated by the pressure of the tip of the finger, astoo sudden evacuation of the tense accumulation may lead to rupture of ves-sels, or, in the case of empyema of the left pleural cavity, to fatal embolismof the pulmonary artery. In these cases the heart is displaced to the rightside,
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