The operative treatment of intra-thoracic effusion / by Norman Porritt.

  • Porritt, Norman, 1858-
Date:
[1883?]
Catalogue details

Licence: Public Domain Mark

Credit: The operative treatment of intra-thoracic effusion / by Norman Porritt. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    If the chest be tapped with a hollow needle its orifice may become clogged with false membrane, derived durmg its passage into the pleura. Should this occur it will inevitably demand the withdrawal of the needle ; for although, by removing the tubing, it may be cleared by the passage of a stilette, while in situ, there is some risk that air will then pass through it into the chest. But if a canula, filled by a well-fitting trocar, be em- ployed, nothing can enter it until the trocar is removed, when the fluid will in all probability pass into it. And should any after-stoppage of the flow take place from a foreign body entering the canula, the running of the fluid can be quickly induced, with perfect safety, by re-introduction of the trocar. There may be an unnoticed kink in the india- rubber tubing, or debris may have collected in it in quantity sufficient to block it. The former event is easily remedied, while the latter is best guarded against by testing the perviousness of the tube with a stream of water run through it before each operation. The flow of fluid can be watched, and its stoppage ascertained by the intervention of a piece of clean white glass tubing in the course of the india-rubber tubing. Lastly, the instrument employed may not be long enough to reach the pleural cavity, owing to the density of the modified pleural membrane, the bulk of muscles or thickness of the adipose layer. Thickening of the pleura is the pathological result of continual inflamma- tion, and is met with in every gradation between a film of flaky consistence and a massive shield as tough as leather. Ccdteris paribus, its density and thickness are commensurate with the length of time the disease has existed. Colles'' speaks of a pleural membrane of several inches in thickness, and mentions a case where he once operated for empyema, and had to cut cautiously through the pleura until the whole knife was in the wound. If the subject of the operation be well nourished and of vigorous bodily developement, not only may thick muscles have to be penetrated, but previous to them, a * CoUes. Dublin Medical Press, 1844.