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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    between the ribs, through which, however, no fluid flowed into the syringe attached to it, until the more practical house-physician pushed it in about an inch further. Or in a very old standing case calcification of the pleura may have taken place, or the rare multi- loculated form of effusion, the result of innumerable adhesions, may effectually prevent the flow of fluid. Concerning muscular development it may be again pointed out that the surgeon can regulate the position of the dorsal muscles by movements of the arm ; and should such an exceptional case be met with, that, from excessive development of the muscles and fat, either the posterior interspace cannot be defined or that the operator's irocar will not reach the interior of the pleura, the spot recommended by Prof. Marshall, on the anterior aspect of the chest, may be selected with a more successful result. The axillary line—in surgical works especially—is often recommended as the most convenient point at which to tap the chest, but only a cursory examination is necessary to indicate the accumulated bulk of muscles which here protects the chest wall. Finally, the surgeon must bear in mind that his diagnosis in a limited number of cases will be at fault, that pleuritic accumulations are sometimes simulated exactly by intra-thoracic growths, and that, therefore, no pleuritic fluid can be evacuated. But, while keeping this fact in mind, he must recollect that his puncture, properly made, does no harm in such cases ; and also, that it may be possible, from a combination of some of the circumstances mentioned, to draw fluid at one point, and fail when the attempt is made at another. Dr. Goodhart mentions a case in which aspiration in the second interspace in front was the only point Irom which the pus of an empyema could be obtained. If, therefore, the dorsal puncture prove barren, exploration in the axillary line, or failing therein, on the anterior aspect of the chest, should not be omitted in any case where the physical signs of fluid exist. A cough or deep respiration will sometimes set up the flow of fluid after an apparently unsuccessful puncture.