The treatment of pus in the pleural cavity differs from the treatment of pus elsewhere on account of certain anatomic, physiologic and pathologic factors. The etiology of the empyema is important as having a definite bearing on the pathologic picture and hence on the treatment.
A majority of the cases seen in infants and children are pneumococcal in origin. In general, it may be said that in such cases fluid does not tend to accumulate with anything like the persistency that is seen in the streptococcal cases, and that there is not the permanency of pathologic changes. Hence, generally speaking, the treatment of the cases need not be as radical as in older subjects in whom there are more often other etiologic factors. In the latter classes, in either pneumococcal of streptococcal cases, but especially in the streptococcal, which predominate in the older subjects, there is more tendency to the