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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    not particularly refer to tlie opinions of the Arabian physicians concerning thoracentesis, some of whom, Rhazes for example, undoubtedly practised it, much as the Greek physicians had done, but none have added anything to our store of knowledge regarding it. Nor do I propose to trace at any length the history of tho¬ racentesis during the seventeenth and eighteenth centuries,—it had been again employed, although very rarely, in the sixteenth ;— such a task is quite uncalled for, seeing that M. Trousseau in the first volume of the u Clinique Medicale de l’Hotel-Dieu,” has already accomplished it in a most interesting and satisfactory manner. Moreover, as the student of medical history is well aware, the subject to which I have thus briefly alluded, is discussed at great length by the erudite Kurt Sprengel in his u Versuch einer pragmatischen Geschichte der Arzneikunde.” It is worthy of note, however, that in the seventeenth century Thomas Willis and Richard Lower, two names famous in connexion with the progress of anatomy and physiology in England, had performed it. About the middle of the eighteenth century, when the employment of the cautery in thoracentesis had become entirely superseded by the knife, the latter method became in its turn supplanted by the trocar. M. T rousseau informs us that the use of the trocar was recom¬ mended in 1765 by Lurde, but that nearly a century before that time its employment had been proposed by Drouin. That the strong recommendation of its advantages by Lurde and others did not obtain for the trocar an immediate or even speedy adoption is evident from the circumstance that surgeons of the eighteenth century so distinguished as Desault and Chopart objected to its employment, on the ground that the wound it inflicted was neces¬ sarily violent (p^netrer brutalement), and that there existed no small risk of injuring the intercostal artery or the lung. As was to be expected, the great discovery of Laennec gave a decided impulse to the performance of thoracentesis, from the aid which auscultation afforded in the diagnosis of pleural effusions. The whole subject is discussed with that author’s usual sagacity as well as brilliancy, in his work on auscultation; but, strangely enough, he withheld his recommendation of the operation, except in cases which were in their nature exceptional. He remarks, u There are two cases of pleurisy in which the operation should be performed. The first of these is when in acute pleurisy the effusion, very abundant from internal abscesses, abdominal and pectoral,—I repeat that Celsus is nearly silent on the subject of thoracentesis, which, on the other hand, as we have already seen, Hippocrates so fully considers.