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CASE 5.
FATAL RUPTURE OF EMPYEMA INTO BRONCHUS DURING
A man of 56, a heavy drinker, contracted pleurisy of the right side. Acopious empyema developed, and had lasted a considerable time before an exploratory puncture revealed its purulent nature. There was no coughing, and the respiratory distress was not excessive. A surgeon was invited the following morning to open and drain the pleura freely. There was no trained nurse in attendance, and the fact that a couple of hours before the projected operation the patient had coughed up half a drachm of pus was not reported to the medical attendants. The patient was nervous, and insisted upon a general anasthetic. Chloroform was given, but violent struggling ensued after a few inhalations. Suddenly, the pharynx and mouth filled up with pus, and in a few seconds a pint or more flowed from the mouth and nose. The pus overflowing into both bronchi promptly drowned the patient in his own pus. Attempts at artificial respiration only aggravated the condition by pumping up more pus, while respiratory and cardiac stimulants were useless.
Obviously, the purulent expectoration denoted the beginning of a bronchopleural fistula, which the struggling under the chloroform rapidly developed. It was unfortunate that the sample expectoration was not shown or mentioned to the surgeon, as the catastrophe might have been averted either by employing local anaesthesia merely, or by the preliminary emptying of the pleura of the bulk of its fluid by the use of the aspirator.
A man of 79, in fair general health, but a member of a gouty family, who had not suffered from any urinary discomfort, noticeable impediment, or frequency in urination, was suddenly seized with abdominal pains and urgent vomiting, which was copious and projectile. The pains were paroxysmal and referred to the lower abdomen, and especially to the right iliac fossa, where a firni elastic swelling could be seen and felt, and which hardened palpably during the pains.
The swelling was only relatively dull on percussion, and there was no obvious hypogastric fullness.
No urinary or rectal tenesmus was complained of. .The bowels had been regular in action, and, after enemata, faxes and flatus ceased to be expelled. Purgatives could not be retained upon the stcmach. and therefore failed to act. This was the only form of visible peristalsis observed.
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