Treatment of Acute Empyema Thoracis with Intramuscular and Intrapleural

For chronic fissure in ano, surgical excision and suture has been practised with surprisingly good results. A stay suture is inserted at the proximal and distal extremities of the fissure which is made prominent by tension on each stay. The fissure is then easily excised with the subjacent portion of the subcutaneous external sphincter. Two or three figure-of-eight sutures of fine nylon are placed, one of which approximates the cut ends of the sphincter. A layer of gauze is wrapped round a small soft rubber tube and the sutures are tied lightly over it. The bowels are confined for six days and the dressing remains clean until the sixth day when the sutures are removed and an olive oil enema is given. The sutures are easily removed by cutting over the dressing. Liquid paraffin by mouth and local Vaseline before defaecation are used for two subsequent weeks, and it is interesting to note that the writer has not seen fistula formation after this procedure. There is also an economy in hospital days as compared with wounds allowed to heal by second intention. Time lost from work in the treatment of a minor disability, although of secondary significance to successful treatment, is nevertheless of major importance to the individual and to the community. The aim of the modificatioins in technique and management which have been described, has been to achieve cure or comfort in the shortest possible time. The guiding principle has been close attention to the smaller clinical and technical details.