On paracentesis thoracis in the treatment of pleural effusions, acute and chronic / by J. Warburton Begbie.

  • James Warburton Begbie
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: On paracentesis thoracis in the treatment of pleural effusions, acute and chronic / by J. Warburton Begbie. Source: Wellcome Collection.

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    off, with a small trocar and canula, about twenty ounces of clear dark straw-coloured serum, having a density of 1030, highly albuminous, and containing a large amount of chlorides. This limited tapping greatly relieved the breathing, but it was far more useful than that; it convinced me, that although the effusion had been in existence from March 1864 to August 1865,—nearly eighteen months,—the compressed lung was still capable of expansion, for upon careful examination of the chest after the removal of the fluid, I found improvement in the percussion note, near the sterno-clavicular articulation, and, on auscultation, heard a distinct though distant murmur of breathing. Accordingly, being assured, by this simple preliminary tapping, of the expansibility of the lung, I drew off, within a day or two thereafter, upwards of one hundred ounces of fluid. This was done with a common trocar, but no air was per¬ mitted to enter. The opening was made posteriorly between the eighth and ninth ribs. This operation, performed in my own house, and without assistance, gave immense relief, and for the first time the patient slept on his right side, and with the head raised in bed only to the usual extent. A blister was applied over the side, and a little iodide of potassium and acid tartrate of potash prescribed. In five weeks there was an accumulation of fluid to such an extent as to make it desirable to repeat the thoracentesis. That was done, and about sixty ounces of fluid were removed. The patient now desired to go home to Stirlingshire, and this I permitted, after receiving his promise to return in the course of a few weeks. He did so; I again tapped him, removing about forty ounces. Again he returned home, and again came back in six weeks according to promise, having meantime begun work as a shoemaker. I tapped him for the fourth time; drawing off about thirty ounces. At intervals, varying from five to seven weeks, I have tapped him three times since; the last occasion was on the 21st April, when, with Bowditch’s syringe, I could only get away eight ounces. There was no more to come; and I have every confidence that another tapping will not be required. The man has gained nearly four stones in weight, eats well, sleeps well, has walked several miles without fatigue, and his breathing is, to use his own words in a letter I lately received from him, u as good as ever it was.” This is a most satisfactory case, and yet I believe it would be far from being remarkable, if physicians placed that confidence in the efficiency of thoracentesis as a remedy in chronic pleurisy, which, in my opinion, it justly deserves. Let me ask attention specially to a few features of interest sug¬ gested by this case, as now briefly recorded.