Visit of the Egyptian Cholera Epidemic in 1883 to Port Said
Authors: G. Kirker
Journal: BMJ (1884)

TH BjtTI DICAL JOV3NAL [Nov.188I,hould be from a %0 to 1, of an inch in diameter, and the puncture should be made in an upward direction, but at the external edlge of the patella.When the joint is emptied, a little styptic collodion is painted over the puncture, a small pad of antiseptic gauze or lint placed over, and tho whole joint evenly strapped up.The leg should be bandaged, and, if thought necessary, an ice-bag is applied to the joint, and the limib, for a day or two, kept at perfect rest, by the application of poroplastic splints.Mr. Jessop has practised aspi- ration successfully in pyinmic abscess of the hipand knee-joints, and has also reported cases of pneuminatic aspiration in ordinary dropsy of tho knec-joiat.In cases of fractured patella, with either effuslon of serum or bluodl, Mir.Christopher Iheatil has now, for some time, prac- tised clmtying the joint by aspiration before putting up the fracture; in tllis way, he has obtainied most happy results.A&soi.-s.-Deep) abscesses of the thigh or ilium, lumbar and psoas abscesses, maLy all be well treated by aspiration.[Mr.Jossett cxhiibitedl and gave a demonstration of anl aspirator suggested by himn, anid manuifactured by lessrs.MIaw, Son, and Thompson, Lonlon, wlichl, from its extreme simplicity and moderate price, may be in the hands of any l)ractitioner.]Dr. FINN Y (Dublin) conifined his remarks to the treatment of puru- letut or sero )urulent efrusions in the thorax.In his experience, the best method was to give free vent, under due antiseTtie precautions, by incision, to tlle fluid, wlichl, so long as it remained, was a source of dunger to thpatient.Never having employed Dr. White's instrument, be hdtd no intention to criticise adversely Dr. White's method of tapping t!he empyema, andl by the siphon method draining it of before le resorted to incision.He protested, however against the indiscrimiuato employment of washing out the pleural cavity with antiseptic 11uiM ; as, unless the fluid were of a dangerous strength, it couldt do littic or niothliug as an antiseptic, and cases wero on record of pati:nts having evidenced toxic symptoms, due to the carbolic acid, the antiseptic ceiploye(l.Dr. G.:x;v (Castlewellan) agreed inl the main with the remarks of Dr. Fiuny, that there was very little dainger, with proper precautions, in opeinh-ng the chest at once when it was ascertained that the effused iluid wuv.e pxs, initroducinig a drainage-tube, and washing out the cavity.As an easy niode of introducing the tube, he recommended a common ute-inie -slmn I to be introduced througlh the enlarged needle-hole, anid pused o:: u itil its point projected between two of the ribs, where it could be cut lowii upon, and pushed through.Upon this point, the draina,e-tubc could be drawn andl tied; then, by withdrawing the somtuid, thc tub, could be brought out through the needle-hole, and the two ends could be tied together.Thlrough this tube the pus drained, and through it tlle antiseptic fluid could be injected.Dr. CULLIMORE (Lonidon) said thiat, owing to the limited time at his dispmosal, he would direct his observations to the treatment by aspira- tion of lhepatic abscess.At the present time, and also during his ser- vice in Inidia, he had considerable experience in the use of aspiration.Sooni after its introduction, it was largely used; but he thought that its early gained success was not attenided with the good results anticipated.Whlen the abscess was deep in the substance of the liver, and the dia- gnosis was doubtful, then, after the lapse of some time to clear up the case, the aspirator might be used, sometimes with success, both as a method of cure, and as a means of diagnosis.When the diagnosis was certain, and the abscess pointed towards the surface, after a certain timne leing allowed for formationi of adhesions, the best method was eitlher to use a trocar and cannula, or even incision, with anesthetic precautions.The objections to the use of the aspirator were that, fronm its great suction-power, it was liable to break down the walls of the abscess, and so increase the danger of the spread of the disease.As a means of diagnosis, in obscure cases, exploratory puncture should always be made.It could be done with safety, and contri- buted greatly, by clearing up the diagnosis, to the peace of mind of the patient.Dr. WHITE, in reply, stated that several of the speakers had misun- derstood him, owing to his having been unable to go thoroughly into the subject from lack of time.He was anxious to correct the misapprehension into which Dr. Finny and Dr. Gray had fallen, as to the statement that air, entering the pleura after antiseptic precautions, was injurious.This was not only not the case, but, as was well known, the introduction of air, rendered aseptic, had frequently been used, and without bad results.Again, Dr. tinny thought that pus was left in the pleuras.On the contrary, irrigation was to be performed by alternate injection and removal of the antiseptic solution, until what returned was quite free from pus ; therefore, what was left behind was merely an antiseptic solution.Carbolic acid either should not be used, or, if employed, it should only be in the strength of 2 or 3 per cent.Nuinerous,ther solutions were to be preferred.