Case of Pleuropneumonia Followed by Empyema; Treated First by Paracentesis, Then by Incision of the Chest: Recovery
Authors: C. S. Ticehurst
Journal: BMJ (1876)

byiiue eiglhteen hours afterwards, and at that time intense cuttinig pain i-as of tin(der the left mamma.The breathlin)g washulrried ; was con- stant coughl, but nio sputa; the cotintenance was anxious.physical signs were duilness at the base of the lung w, slight tvgophony and dinsinished tactile vibration ; highel-u), there were breathing and bronchophony.No rub could dletected.LDecubitus -as dorsal.I'Ulse, 114 ; temperature, 104.4 respirationss, 'Tbe coitents of the right side the tlhorax were lcalthlly.April 26th.Some urine procured to-day was founnd trace of chlorides and no albumen.April 28th.There were wvell marked sput.a.red patch over each cheek-bcane.The pain underthc lcft was 'Tlhe temperaturelhad fallen.No sleep was obtained, sedative drauglht.April 30th.The physical signs were follows.was Universally dull, with absence of tactile vibration.lTubuilar was heard anteriorly at quite the upper part the cliest, and, p)osteriorly, close to the spinec, nearly to the base.Elsewhere, breath- souniids were distant.Tlreie was a crop herpes abouit miiouthtl.T''ie heart's imt pulse Nwas diffused tl side, was stippler yentary MaY 3rd.T'hee chlorides reappeared in lihe urine on the ist instant.''lhec temperature and respirations adi fallenl (s.s.Chart).The general condition was fair.Ioli(e and acetate p)otah 'were being given, witit two grains of pilula hydl argyri, nhight and niini-i, g, and d the affected Mide was painted with tincture of iodinie.M.y 9th.Aniteriorly, the breathi-sounids wsere heard to nipple, and noot s,o o tubular in character; the percussion-note wvas niot ; tactile vibrationi wvas also slightly felt region.Below the and nd ounid in thec axilla, the signs of efftusion remained before.te-ior-ly, the breath--sounds were not markedly tubular.The sputa werc witeic anid scanity; therre was diarrhoxa, and thl e mouth was slightly tender.The effusion seemed to iave slightly decreased.The pills were stopped.MY 14th.The temperature had upward evening exacerbatiois alternating with considerabe mornninn g remissions.Nightly perspirationis were complained of, also a feeling like that of cold water down the back.The hysical signs hiad niot mutch altered since th last report.Inispection of the chest showed that thie left apex " lagged" behind the right during g reespiration.The pl)uls was fairly strong.PleInty of niourishiment was taiken.Th e diarrhbea had nearly ceascd.There were no o sputa ani(I very little cough.Thlle apex-beat wfas felt at thee sternum.The patient read with pleasure, and was not at all distressed by the amnouunt of flu id.Ma'y 26thl.'[lie chills and soaking plerspilration-hiad conutinued.The hecart was niow coiisideuab'ly displaced over to the rigtt; its im- liilse cottld not be felt at all on the left side, whlich was absolutely dull Lti) to the clavicle, with absence of all tactile vibrationi.The breath- soundls were very distant; there was also oedema of that side, The -temperrature curve at this date will be best seent by reference to the chart, Thisnmorning, thietemperaturebhadfallentobelownormal.There had been an alarming threatening of syncope; anil there was lividity -of thc li'ps with