This paper is limited to a consideration of empyema in its earliest stage, when loculated, first, between the lung and the chest wall; second, between the lobes, inter-lobar; third, between the diaphragm and the lung. It should be our aim to determine the presence of small collections of pus in the pleural cavity. It is no credit to the profession at the present time to send to the surgeon a patient with the chest half filled with pus or even with half a pint or a pint of such accumulation. Members of the profession have not taken to heart the lessons of Murphy,1 Willard2 and Eisendrath2 and the excellent essays and reports of Withington, Sears, Jackson, Munro and others.3
The force of the necessity of recognizing early small collections of pus can be appreciated only when we recall the disastrous results that follow accumulations of large