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

  • Begbie, James Warburton, 1826-1876.
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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    The fluid was still serous, at the distance of sixteen months from the commencement of the illness, and it continued so, changing a little in colour, becoming pale, and losing in density, till twenty-five months after the attack commenced, when its formation may be said to have ceased. I have known the fluid to remain serous for a much longer period, indeed, for several years. It did so in the case of a sailor, who was under my care in the hospital eight years ago. I tapped this man’s chest on three occa¬ sions, removing between fifty and sixty ounces of serum at each time, dark in colour, and free from any smell. The first quantity removed was found to contain cholesterine in considerable amount. The man, finding himself much relieved, insisted, greatly to my regret, on leaving the Infirmary, and so the subsequent progress of his case is unknown to me. That the right lung—his was a pleural effusion on the right side—had expanded to such an extent as to make it hopeful that the case might terminate as favourably as the one now related, I was convinced, but I am equally sure, that after a time and for a considerable period the fluid would slowly re-accumulate, rendering repeated tappings necessary. 2d, I have mentioned that blisters were used, and that diuretic as well as deobstruent remedies were employed after the performance of thoracentesis. Such cannot be expected to act with the same degree of energy as when used in like circumstances in the acute effusions; but, still, I believe their action to be far from wholly inert; used independently of tapping they are useless. Again and again I have seen them employed in cases of chronic pleurisy, diligently and for a lengthened period, but never can I say that any decided benefit resulted. 3d, The tapping earliest performed in W. H.’s case was tenta¬ tive. I ask attention specially to this expression—for had the lung not given evidence of expansibility after its employment, I should either have adopted a different practice, as in other cases, or on subsequent occasions used the measure as one purely palliative. The lung did, however, expand, affording evidence that after many months of compression the return to a healthy condition is quite possible. To attempt either in the case of a chronic serous effu¬ sion, or in that of an empyema, the removal of other than a moderate quantity of the effused fluid, until the capability of the lung undergoing expansion has been ascertained, is, I think, a dangerous practice. True, it is only by strong suction power, which in such circumstances is not safe, that we are able to remove any very considerable amount ; but, I repeat, a safer and better plan