Thoracentesis and its general results during twenty years of professional life : remarks made at a stated meeting of the New York Academy of Medicine, held April 7, 1870 (by invitation) / by Henry I. Bowditch.

  • Henry Ingersoll Bowditch
Date:
1870
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Licence: Public Domain Mark

Credit: Thoracentesis and its general results during twenty years of professional life : remarks made at a stated meeting of the New York Academy of Medicine, held April 7, 1870 (by invitation) / by Henry I. Bowditch. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    member that when Dr. Wyman first performed his brilliant ope- ration with the exploring trocar and eaniila and siiction-pump,— although the patient rapidly recovered from impending death and terrible distress,—the cry of eminent surgeons in Boston was not at the success, but rather the imprudence of tlie operation. Before I saw Dr. Wyniaii's method, I had thought much upon the subject, and for years had to fight against the iiroposition laid down by my excellent master in medicine. Dr. James Jackson, that nature will generally carry off fluid from the pleura, provided there be no sei-ious complication, such as tubercle, in the case. Doubtless the majority of cases of pleurisy go through these va- rious processes towards cure, even with the simplest, or with no treatment; but thei-e are, I am sm-e, numbei-less cases in which thoracentesis will hereafter be used with success which lieretofore have been allowed rapidly or slowly to go on towards death. Many years ago I was convinced of the truth of the latter jinrt of these remarks by the following cases:—A sailor atClielsea Ilosjii- tal had been ill for many months with what, at that time, was an obscure affection of the cliest. It was supposed to be sotne ma- lignant disease. I was very desirous tliat the surgeon should plunge in an e.vploring needle. It was contrary to tlie rules of surgery, and lie shrunk from the proposition. The patient died slowly, worn down by the disease, and at the autopsy an enoi-- mous quantity of serous fluid was found in one pleural cavity, witliout a trace of disease in the other parts of the body. Soon afterwards I saw at the Massachusetts General Hospital a young woman who, in previously ]ierfecl health, had acute pleu- risy with a large etl'usion. I watched it imder the care of another, and after months of illness, phthisis set in and she died. The thought occurred to mo whether relief of severe symptoms migiit not Imve been obtained, or perhaps even the phthisis itself p>re- vented, if thoracentesis had l)een performed in the early period of the disease. That tubercles were consequent, not precursors of the disease, I now, under the light of modern medicine, fully believe, as, in fact, I really thought at that time. Finally, about 1848, another case of a similar character occurred under my owti care, when attending physician at the hospital. I called a consultation of my colleagues, and asked if an operation should be performed. An mianiraous Nay, with the exception of my own affirmative vote, was the result. I then determined I would ask no furtlier consultation, but would take the responsi- bility, and ask the surgeons to operate for me. Not long afterwards, a case of ckronic pleurisy came to the hospital, and thougli an unfavorable case, I asked the late Dr. J. M. Warren to operate, and he did so in the presence of liis father. It was done in the usual mediaeval* manner, viz.: by cutting * This expression, I fear, is somewhat too severe, if applied to all cases. The excelleut remarks and surgical cases quoted by Dr. Teale, who saw the happy results of such an operation in not a few cases of gun-shot wounds during the late rebeUion, fully prove that the operation, though, as