Bismuth paste in chronic suppurations, its diagnostic importance and therapeutic value . the sinuses continued to discharge. Four weeks laterI injected 30 grams of paste. The secretion changed from that of pusto serum, and two weeks later the sinuses closed. Another illustration is the following case of empyema: B. had pneumonia, followed by empyema, in the fall of 1909. A re-section of one rib was performed and drainage instituted. The sup-puration continued, however, for several months, when he was broughtto me for treatment. After estimating the size of the cavity by radio-graph, I injected
Bismuth paste in chronic suppurations, its diagnostic importance and therapeutic value . the sinuses continued to discharge. Four weeks laterI injected 30 grams of paste. The secretion changed from that of pusto serum, and two weeks later the sinuses closed. Another illustration is the following case of empyema: B. had pneumonia, followed by empyema, in the fall of 1909. A re-section of one rib was performed and drainage instituted. The sup-puration continued, however, for several months, when he was broughtto me for treatment. After estimating the size of the cavity by radio-graph, I injected 16 ounces of the 33-percent bismuth-vaselin (Fig. 76) shows the size of the cavity. The paste was BISMUTH POISONING. 197 retained for ten days, and during this time the patient felt absolutelywell, but thereafter he began to complain of lassitude and loss of appe-tite. An examination of the mouth showed the first symptoms of bis-muth absorption—i. e., a bluish discoloration at the margins of thegums and also bluish rings around the follicles of the tonsils. Within. Fig. 76. Empyema filled with bismuth paste, causing symptoms of absorptionin two weeks. Prompt removal of paste resulted in complete recovery and cure. the next twenty-four hours small ulcerations began to appear back ofthe wisdom teeth. The chest cavity was at once washed out withwarm olive oil and the paste withdrawn with suction pump. (Fig. 77.)The cavity was refilled with sterile vaselin in order to prevent theentrance of air. The secretions in the meantime had become abso- 198 BISMUTH PASTE IN CHRONIC SUPPURATIONS. lutely sterile and reduced in quantity. The symptoms of bismuthabsorption at once began to disappear, and within three weeks not asign of them remained. The cavity was treated by repeated suctionto expand the resilient lung. Two more injections of a 10-percent bis-muth paste were given at intervals of ten days. Finally all the pastewas withdrawn, the cavity closed, and now the cont
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