If left to Nature the destiny of pus within the pleural sac would be: first, absorption; second, formation of a pleural vomica; third, perforation of the chest-wall, resulting in empyema necessitatis; and fourth, perforation through the diaphragm into some of the abdominal organs or the peritoneal cavity. Of these several results, all quite rare, that by way of formation of pleural vomica is probably the most frequent.
Dieulafoy,1 in the 1911 edition of his work on practice, says:
Considering only its etymology, the word "vomica" (from vomere, to vomit) is improperly applied to the symptom which we are about to describe. Custom, however, has consecrated it and the word "vomica" serves to describe ejection of pus by respiratory channels just as hemoptysis denotes the ejection of blood from the same passages. Custom has even gone further and by an abuse of language has finally included under one term the
SMITH E. PLEURAL VOMICÆ: WITH AN ANALYSIS OF SIXTEEN CASES. JAMA. 1912;LIX(23):2031–2035. doi:10.1001/jama.1912.04270120016004
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