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
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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    thoracic symptom, and tlie sole fact that led his northern attend- ant to discover a pleuritic effusion was tlie statement from the aunt tliat during sleep, the youth seemed at times to breathe with difficulty. Accordingly the physician liad examined, and was highly surprised to find proof that one pleural cavity was full of fluid. I tapped him the next day, my theory being that the fluid had been very gradually accumulating for months, viz. : from his first attack of fever. I drew off a large quantity of serum with entire relief to all the fibscure symptoms that had been depressing liim. In twent3'-four hours the lung was fully expanded, and in less than six weeks the youth was careering around on lioiseback, in all the elasticity of perfect health, which he had not had from the time of his first attack. An aged physician of Boston had liad pleuritic effusion for several weeks. He had no severe symptoms; but knowing the ex.act condition, and being aged, he dreaded the idea of paracen- tesis. I finally i)ersuaded him of its innocuousnesa, and of the j)robable relief he would obtain. I drew off an equally large quan- tity of serum with complete relief, the lung expanding aftervvai'ds freely. The recovery was rapid. Finally, I will mention the case of an active merchant, aged 62 years. lie had .always been in robust health. He was inor- dinately fat. It was with the greatest difticidty, and only on the strongest pressure, that I could distinctly feel the narrow * inter- costal spaces. Feb. 13,1867. I saw him in consultation. The ])Ieurisy had developed itself with great insidiousness, but auscultation had clearly i-evealed the gradu.al filling up of one pleural cavity. He had, at my visit, a short dry cough, which had shown itself chieHy during the preceding week. Previously to that time he had driven into Boston to business daily. I found him restless and nervous, and with a certain pressure of breatli, but no pain or fever. Pulse 70. The left side was full, and the heart was thrust high up to the right, the impulse being in fact felt chiefly tinder the thin.1 rib. I jwoposed tapping immediately. The tube usually employed, thougli driven up to the hilt, was too short, as tlie motion of the patient constantly drew it out a line or more from within the pleural membrane. I was obliged therefore to get an instrument very much longer, and by forcing this as one would through a thick layer of fat pork, I finally succeeded, on the following day, in drawing from the chest several (3A) pints of serum. Not a trace of evil consequence followed the two punc- tures. On the contrary, the lung slowly but surely expanded, * The books declare that in cases of large effusion the intercostal spaces of the diseased side are wider than those of the other. This perhaps is usually the case, especially when nature has pointed, and an abscess is forming. But it is far from being so in very many instances in the period of the disease when I have tapped. On the contrary, there has often been, as in this case, a contraction, spasmodic apparently of the interco.stal mus- cles, and the spaces between the ribs have been exceedingly small on the dis- eased side, while those on the healthy side have been much widened.