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.

Bowditch, Henry I. (Henry Ingersoll), 1808-1892.

Date:: 1870

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.

19/96 (page 11)

$had liver complaint in the spiinsc, and since then had been unwell, lie had dys))nfBa and cough, and pain in the left side. Wlien I saw him he had orthopnoea, and had been confined to his bed. He was emaciated, and appeared very ill ; it was thought lie would not recover. I found evidence of pleuritic effusion into the left side of the thorax, with dislocation of the heart, some bronchial respiration and mucous rales in both lungs, some being distinct in the left back, just at the usual pointof puncture. I felt it necessary, however, to explore, Itecause it seemed as if he would certainly die soon unless relieved. I feared hopeless disease—but I felt equally sure that it was right to give the chance of relief by taiii)ing. Accoidingly I introduced the trocar in the usual place in the back, but where I heard distinctly tubular respiratory mur- mur and nnetpiivocal rS,les. In fact, the seventy of his sym])toms, and my knowledge of the innocuousness of the operation, led me to introduce a trocar in a spot which, according to the usual interpretation of physical signs, I should have avoided. Never- theless I drew out thirty-four ounces of serous fluid, with immedi- ate and permanent relief. lie began to improve forthwith. No attempt of reaccumulating occurred, and all the rational signs soon disappeared. January 4,1869. lie had been at work two months. Marcli 1, 1809. Scarcely any difference between the two lungs, and rales all gone. tSecoii.d.— To prokiyiff life, even with the severest eow2)licati<m$. The following is a striking ease of this nature. I was called to an old man, ret. about 70, who, after having had cardiac disease with hypertrophy for many years, was suflering with general dropsy of the legs and abdomen, and more recently an effusion had taken place in the ])leural cavity. He had permanent orthop- ncea, and certainly did not afford any rational ground for the hope of obtaining anything more than a temporary relief. I told liim I believed that if we could obtain fluid, he would be mate- rially relieved of his severe symptoms. At my visit he was a ereat sufterer, and the left pleura was full of fl«iid ; a large rpian- tity of serous fl\iid was immediately drawn ofl, with not only en- tire relief to the orthopncea, but subsequently the eft'usions left the abdomen and legs, and the patient lived in comparative ease for two years afterwards, when he died of his cardiac disease. Third.— To shorten late/ifplcurisi/. The three following cases are in point :— A youth from New Orleans, long before the late rebellion, was taken ill with febrile symptoms, and was said to have Southern fever. He siradually got better, but never recovered wliolly, and, after months of deteriorated health in the South, he came up to the North to recruit his shattered constitution. When in New Jersey, he was taken down anew with feljrile accesses, and was then s.aid to have an attack of Northern fever. Finally, he arrived at the vicinity of Boston, and I was summoned in con- sultation, and was told the following tacts. There had been no$