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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    conscience of this community the following propositions, which I consider perfectly well-established axioms for me to rest upon :— 1st. The perfect innocuousness of the operation, if performed carefully, and with due regard to the feelings of the patient. 2d. The certainty of relief following sooner or later, if fluid be removed. 3d. The certainty that it sometimes saves human life. 4th. We inust put wholly out of our minds that it is to be used as a last resource ; but, on the contrary, take the ground that thoracentesis (by Dr. Wyman's method, that is to say) should be used, whenever symptoms require it, as readily as you would use any other remedy, a cathartic, a blister, a subcutaneous injec- tion, etc. OBJECTIONS TO THE OPEKATION. I think it best to meet here and answer all the objections that I have heard urged against the operation. It is said that it is of no use to perform the operation, because all uncomplicated pleuritic effusions will get well under other treatment, or under no treatment at all. But if we grant that this may be generally true, it is entirely denied as a universal proposition. Death, or long-continued disease, will at times hap- pen in every one's practice who stubbornly holds to this opinion. 2d. It is asserted by some persons that complications should prevent us from performing it. Never was there a falser theory, — one wholly unfounded in fact. The cases reported above fully prove the error. No matter what kind or amount of complications exist, the more they are in number, the c/reater the reason for thoracentesis. 3d. We may injure the lung with the instrument. Well! suppose we do tap the lung, what harm results? Uow often is the lung injured by broken ribs, and no evil comes? I have struck the lung at times—I have seen another draw blood from it—yet with no evil results. 4th. W^e injure the lung by forcing it to expand. I have never seen this happen, perhaps because I always cease to draw imme- diately that the patient begins to suffer any really uncomfortable feeling, such as stricture of the chest, etc.* 5th. It is said we cannot draw all fluids. This is a ])00r ob- jection. W^e can at least try to get fluid, but it is not a valid reason for refusing to perform the operation. 6th. W^e may admit air into the pleura. Suppose we do. No harm usually results. I have at times accidentally pumped in one or more ounces. No trouble ensued. It is true that if a per- nuuient opening be made in a case where serum simply is in the * After my remarks, Dr. Geo.T. Elliot remarked that pneumothorax came on in one case in which he operated, and Dr. F. Barker said he had three times known of severe pain in the side after the operation. I ask myself if these gentlemen may not, in their earnest and honest endeavor to remove as much fluid as possible, have continued the suction too long.