PART II. PRACTICE OF SURGERY

SECTION IV. OPERATIVE SURGERY

Part 18. 2. Thoracic

Purulent collections in the pericardium and pleural sacs may he treated as ordinary abscesses by incision. In the case of the pleural cavity the pus may be evacuated through an opening made in the axillary line at the seventh costal interspace ; but it is imite possible to empty it thoroughly at the fifth. A drainage-tube is inserted, protected by a broad flange, that it may not slip into the cavity, and strict asepsis should he secured. Should sepsis occur, the wound should be washed out, and a counter-opening made if necessary. As the lung, however, frequently will not expand, and a large cavity is therefore left to heal by granulation, with little chance of it ever getting filled up, surgeons have excised portions of the ribs in order to bring about a collapse of the chest wall and thus ensure obliteration of the cavity. The second, third, fourth, fifth, and sixth ribs have been partially removed, together with a portion of the clavicle. It is better in young people to remove the periosteum also. Some surgeons cut away the thickened pleura as well. The possibility of opening into the pleural sacs and peri-cardium for the removal of tumours has been demonstrated by Kônig and Krister, who have reported cases where growths in connexion with the sternum and ribs were successfully removed. Special care was taken that as little air as possible should gain access to the pleural cavities. Attempts have also been made to tap and wash out vomicae in the lung, but as yet operative interference in such instances is not fully established.






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