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
Catalogue details

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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    slowly flown and jTradiinlly openiiip; the pleura. It left a lara;e gaping wound ; and althouuli pus was disciiaiged, the patient did not rally much, and soon afterwards died. Consequently, I decided tliat unless surgery could do better than that, I would none of it. 1 was satisfied, iiowever, that a way would be found to treat such eases. About this period I read the facts recorded by Messrs. Hughes and Cock, and spoken of above. In 1849 I was called to see a young child who had one ])leural cavity (//);>ar<,'/i% but h.alf-full of fluid, and yet bad had one or two attacks of excessive orthopnoia. I asked a surgeon to consult with ine about using the common trocar. At our visit the (.'hild was sitting apparently so easy in his mother's lap, that, on mature consideration, we determined to wait until dyspnoea should again set in. Never was there a more fatal error. I should not wait again in such a case. The child died in a tit ot dyspnoea the night following our consultation. I asked ]iermis- sion to ]ilunge a trocar into the affected side, which fully con- firmed the diagnosis by allowing ])us to escape. Allow me, in anticipation of my suljsequeut experience, to say, that I doubt not that we often mistake in our estimate of the ariioxmt of fluid in the chest: we are misled by the tynipanitio resonance of the upper ]iart of th^' thorax-, which may happen even when a large quantity of fluid is contained in it. In 1850 occurred my first case, in which Dr. Morrill Wyman used the exploring trocar and canula with suction-pump at- tached, and which I immediately saw was the apparatus I liad long soui,'ht for. That ajiparatus I have modified soinewhat, so as to make it, I think, more convenient; l)ut the principle of the instrument remains as suggested* by Dr. AVyman. The patient was a young house-painter, wlio had fallen from a certain heiglit about five or six weeks before I saw him. Cough had set in, with copious s))uta and emaciation, itc, and many of the 3ym]itoms of phthisis, in fact. He was supposed by physician and friends to bo dying of rapid consumption. The ]>rominent symptoms when I saw liim were orthopnoea and emaciation, and great distress; and his pulse was at 120. I found positively effusion into one pleural cavity,possiblt/ tuberculous disease of the Jung; but of the latter part of the proposition there was no pii'oof. I suggested that the only reme<ly to be tried first was thoracen- tesis. The fi'iends obstinately refused to allow it to be done. The man had made his will anol taken leave of the world, and they undertook to say that nothing should be done. I stated my opinion to the patient, and he, despite of opposition, decided to allow me to do whatever I thought best. Fortunately, I had heard of the very successful case under the care of Dr. Wyman, I still think, rather unadvisable in cases of pure chronic pleurisy, may be very useful in some cases of fluid in the cavity of the thorax, or in cases of injury of the thoracic wall, with subsequent formation of pu.s. * By this instrument we give less pain and leave no wound, which can- not be said of any other apparatus before employed.