CHICAGO PEDIATRIC SOCIETY

Abstract

Although empyema was known to the ancients and the importance of drainage was recognized by Hippocrates, there are few surgical conditions that have aroused more discussion the last fifty years concerning the method of treatment. The present concept of aspiration in empyema is that it is not satisfactory and should be used only as a temporary procedure for the purpose of tiding a patient over the acute pneumonia stage of illness, with the expectation of establishing adequate drainage later if necessary. A new method of treatment is not being advocated, nor is it being claimed that all patients can be treated by such methods. A series of thirty-seven cases of empyema is reported ; the patients were treated at the Children's Memorial Hospital 1928. These patients were taken consecutively. Thirty-three were treated by aspiration. The other four were operated on for the following reasons: two patients had discharging sinuses ; one, the attending man, had requested that surgical treatment be used, and the fourth patient had been treated by aspiration outside the hospital and the needle had broken off in the chest cavity. The method has been to aspirate with a number 15 bore needle, with the patient under local anesthesia. Pneumothorax developed in 50 per cent. Five cases occurred spon¬ taneously before aspiration. The following organisms were cultured : pneumococcus 29, hemolytic strepto¬ coccus 2 and staphylococcus 1. No culture was taken in one case. The average stay in the hospital was from twoi and one-half to three and one-half months. The mortality rate was 9 per cent ; one patient died a week after leaving the hospital against advice. The other patients consisted of an infant, aged 21 months, who died of pneumococcus meningitis, and a boy, aged 6 years, with a bilateral empyema. Frequent roentgenograms were taken the patient's stay in the hospital and on his return visits to the outpatient department in order to show a graphic record of just what happened to the patient during a year. Physical observations characteristic of practically all cases have been : no deformity of the chest, excursion equal, resonance not impaired, breath sounds on normal inspiration distant, on forced inspiration practically normal. The children had gained in weight, did not cough and seemed to lead a normal active life.