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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    but it was used only, or almost onl}', when nature, by local prom- inence, had selected a spot for an operation to be made, by herself or by the surgeon. In other words, when an abscess was formed the surgeon simply lanced it, or cut down upon and opened it cautiously with his bistoury. Not until Laennec made his inval- uable discovery of auscultation, could a fair diagnosis of cases be made. By this discovery a large class of cases were laid open before us which were wholly unrecognized before. In these pre- viously unknown regions of diagnosis now lie, and will forever hereafter lie, most of the fairest cases for thoracentesis. But even now the majority of the profession do not know how to avail themselves of the knowledge thus given, or they dare not^ avail themselves of it, even to relieve an untold amount ot suflering. Men who would not hesitate to plunge a trocar into, or even to lay freely open, an abscess lying under the peritoneal walls, will refuse to attempt to alleviate orthopnoea threatening death, aris- ing from the accumulation of fluid in the thoracic cavity. On the continent of Europe, about 1840, Trousseau was almost, if not quite, alone in recommending thoracentesis. He had no fear of performing it—but he used a much heavier instrument than that which I have always used—an instrument better fitted, in fact, for the side of a barrel than for the human chest. Vallcix* was at the same time opposed to it—and doubtless Vallci.x expressed medical opinion, while Trousseau was the prophet of the future ! In Entjland, no one heartily defended the operation until Messrs. Hughes and Cock published cases of successful result in Guy Hospital Reports.f Biit it may be fairly asserted that the profession in Europe, as abody, ignored italtogether, and thereby, as I think, have allowed some persons to die who might have been saved—or they violently opposed it because most cases, when left to the slow and tedious process that nature at times, sets up, and which at a late hour have been tapped, usually turned out badly. By the operation I shall suggest, I trust that hereafter we shall not wait ibr nature. We shall rather direct than follow her. In this country we have, mi til of late years, followed the guid- ance of Europe ; and the terse and sharp remark made to me (when I first began to operate) by one of the most noted auscul- tators of America fully expresses the real state of medical public opinion. From what I knew of his conservatism, I anticipated that he would object to it, and I was not surprised, there- fore, when, to my rather quiet and deprecatory question, as to what he really thought of the value of the operation, he quickly replied, I would as soon send a bullet into the chest as pluncre a trocar into it. Evidently, to his mind, death was equally lia- ble to occur from either operation ! Though rather strongly sta- ted, I cannot but think that this remark was about the result to which medical opinion had arrived in this country. I well re- * Ouide du Mtdecin Pratkien, &c., vol. i., p. 564. Paris, 1850. f Guy Hospital Reports, April and Oct., 1844.