Paracentesis thoracis as a therapeutic agent : introduction to a discussion in the Section of Pharmacology and Therapeutics at the Fifty-second Annual Meeting of the British Medical Association / by W. Henry White.

  • White, W. Henry. (William Henry)
Date:
[1884]
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Licence: Public Domain Mark

Credit: Paracentesis thoracis as a therapeutic agent : introduction to a discussion in the Section of Pharmacology and Therapeutics at the Fifty-second Annual Meeting of the British Medical Association / by W. Henry White. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    *3 ficulty encountered in introducing a drainage-tube or probe, which is at once directed upwards by the diaphragm along a narrow sinus, slipping in easily after it has overcome this obstacle, into a wide cavity. The irritation of this tube prevents adhesion between the two layers of the pleura, and keeps'up the purulent discharge. A greater danger of syncope exists in this operation, induced by the sudden removal of tension, and is a strong argument in favour of previous paracentesis to prepare the patient. The difficulties in the way of treatment are much intensified when we have to deal with purulent effusion subdivided by bands and adhesions, or the condition which has been named loeulated empyema. These cases may require the use of bent probes, the catheter, or per- haps the introduction of the finger, to break down the connecting bands, if injections have failed. The after-treatment of empyema will consist in complete rest in bed for some days, with plenty of light nutritious food, and stimulants, if necessary ; the administration of tonics, and more especially quinine and cod-liver oil, or the ferruginous preparations, and hypophosphites. But fresh air without fatigue, and, if possible, an early change to the seaside, will probably work wonders. A time arises, sooner or later, in the treatment of old-standing cases of empyema, when improvement ceases; the flattening and deformity of the side is complete ; the expansion of the lung, and the elevation of the diaphragm, are exhausted, and incapable of obliterating the pus- secreting cavity, the drain from which will exhaust the patient, or kill him by producing albuminoid degeneration of his organs. We have then to deal with a cavity which can only be closed by one method ; I refer to resection of several ribs. This ancient operation, which has been recently revived, and is advocated by Thomas, Kcenig, Howse, and others, may be performed with a twofold object: (a) to allow the ribs already approximated to fall in more completely, in order to obliterate the cavity remaining between the diaphragm and the lung ; (b) in order to permit more room for the drainage-tube ; but Mr. Marshall has recommended the removal of the upper portion of the rib as sufficient for this purpose. The operation consists in the removal of portions of several ribs, about one inch and a half in length, in adults. This is done through a T-shaped incision, in the axillary line, over the ribs that have been chosen, the periosteum having been stripped off before the bone-forceps completes the division. A drainage-tube is then inserted, and the wound dressed antiseptically. Portions of four ribs at least should be removed, including the fifth and sixth, which are essential to its success. The operation of paracentesis may be call ed for occasionally in pneumo- thorax, or, more correctly speaking, in pyo-pneumothorax, whether this condition has arisen as a complication of empyema, pulmonary phthisis, or of gangrene of the lung. In the two latter, it is frequently- undertaken, in order to ward off suffocation ; and is, therefore, merely palliative, although cases have sometimes been benefited. In phthisis, the fluid frequently appears to exert a beneficial influence, and may arrest the course of the disease. Attention has, of late years, been paid to the drainage of lung- cavitics, and with occasional success. The operation has been under- taken in various conditions of the lungs, and we may mention the fol- lowing examples : (a) in the cavities existing in bronchiectasis • (h) in the cavities which concur with pulmonary phthisis ; (c) in those resulting from abscess or gangrene of the lungs. The difficulties in the precise diagnosis of cavities arc so great that their treatment by drainage is sometimes well-nigh impossible and this is more especially the case as wo approach the apices of the lungs Whether it is justifiable to tap all the various cavities to be met with’,
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