271 De Morbis, lib. i. p. 448.
Hippocrates's operations were made by boring through the rib or with a red-hot iron or a bistoury cutting through the intercostal space. Galen (A.D. 150) had his pyulcon with which to draw out the fluid. Galen and Roger of Parma bored through the sternum. Many of the ancient surgeons, such as Eumphon of Cnidos, Paul of Ægina, Celsus, Solinger, divided the soft parts by caustics and the knife after laying bare the pleura. Blunt instruments were sometimes used, such as sounds. Celsus in his latter years lost confidence in the operation, and it fell into discredit among the Greeks and the Romans, by whom it seems to have been nearly abandoned. In the Middle Ages the question was discussed whether it was better to open the chest by steel or by fire in traumatic pleurisies. Trousseau states that about the sixteenth century the operation of trepanning the ribs was revived. About the same time the detersive injections which had been recommended by Galen were again advocated, especially by Fabrice d'Aquapendente. The operation was unpopular among the greatest surgeons, and but seldom resorted to except in extreme cases. Notwithstanding the servile obedience to tradition in those days, some important points were advocated in regard to the propriety of allowing the openings for empyema to remain unclosed for an indefinite period. From the seventeenth to the eighteenth century the operation of paracentesis was the topic of many surgical treatises.
Early in the seventeenth century practitioners became less distrustful of puncturing the chest, and were led to believe in the harmlessness of the operation (Trousseau). As a consequence of this tendency, physicians began to study the question of puncturing the chest in hydrothorax. In 1624, Gérome Goulée alleged that he succeeded more frequently in hydrothorax than in abdominal paracentesis. Twenty years later, Zacutus Lucitanus asserted that paracentesis was as necessary in cases of serous effusion into the chest as incision in empyema. In 1663, Robin and Duval recommended thoracentesis as the best treatment for hydrothorax. Some time afterward this practice was put in force by Willis. Lower also mentions a case, and subsequent authors quoted these cases as an encouragement to the performance of paracentesis of the chest for the removal of serous effusions. Jean de Vigo brought out again the pyulcon. Druin about the year 1665 proposed the use of the trocar as a substitute for the actual cautery in opening the chest.
In 1658, Bontius for the first time took up in a precise manner the subject of the introduction of air into the pleural cavity. He declared there was no danger from it. Bartholin maintained the opposite opinion. The indications for the operation were laid down, but they were necessarily very imperfect. In proportion as attention was directed to the question of the admission of air, the manner of operating was modified. In 1669, Scultetus discussed thoracentesis in his work Armamentarium Chirurgicum. He made use of a trocar, with a bladder at the external orifice, principally to prevent the introduction of air, as Reybard later used a piece of cat's intestine and a bladder of gold-beater's skin. Scultetus used the sypho, a common syringe, for injecting the chest, and also the [Greek: pyoulchon] ([Greek: pyon], pus; [Greek: elchô], to draw out), or pyulcon, for drawing out matter, as its name indicates. This was practically the syphon. Scultetus describes the operation by incision with his gladeolo salicet longo, and by puncture with the canula et acus, both figured in his plates; so also his drainage-tubes, with directions for shortening them as the cavity heals, and the long tubes, which probably acted by gravitation after the manner of the syphon. Aspiration was made by the mouth, by cups, and by syringes affixed to a canula or catheter.272
272 These facts were kindly furnished me by Morrill Wyman, who carefully examined Scultetus' work (edition 1672) in the Harvard Library.
It is thus evident that more than two hundred years ago aspiration was used to evacuate fluid from the pleural cavity. Trousseau says that "at that period aspiration and suction were used for this purpose—timidly pursued, in accordance with Scultetus' example; and that it became afterward in vogue with the masters of surgical art."
Palfin preferred the trocar to incision for treatment of hydrothorax. In 1707, Anel wrote a book on the art of sucking wounds without using the mouth. Bourdelin (1742) rejected the trocar for fear of injuring the lung. That Scultetus' practice was continued is evident from the work of Laurence Heister (1742), who described puncture of the chest, with drawings of exhausting syringes for the removal of pus or serum.
In 1765, one hundred years after Druin's use of the trocar, when perforation by actual cautery was abandoned, Lurde timidly advocated it on account of his fear of wounding the lung. He advised the operator to close the canula with the finger at each inspiration, leaving it open during expiration, so as to prevent the entrance of air. Chopart and Desault opposed the use of the trocar as a coarse mode of operation, involving the risk of wounding the intercostal artery and lung (Trousseau). Van Swieten at the end of the last century questioned the advisability of using the trocar. Later, in 1796, Benj. Bell,273 in cases of thoracentesis, used india-rubber bottles fitted to the opening for the same purpose, first compressing them and then allowing them to expand by their elasticity. He strongly recommended paracentesis of the pericardium when the amount was so excessive as to cause death. He gives exact directions how and where to operate.
273 Vol. v.
Isbrand de Diéonerbrock274 plunged a bistoury between the fifth and sixth ribs, and introduced into the wound a silver canula large enough to fit the orifice, and stopped the canula with a tent which he withdrew each day. Jean Scultetus275 recommended several different canulas, some of silver, some of gold. He also invented syringes, straight and curved, to absorb the pus or make injections into the chest. Scultetus operated in the sixth intercostal space; he raised a piece of skin, so that it might lap over the orifice after the operation. He used a tent until the eleventh day, when he inserted a canula. After Scultetus, Lamzweerden276 used suction, and contended that it was very successful. Paul Barbette277 considered thoracentesis as indispensable in empyema and hydrothorax. He maintained that it was less dangerous than the puncture for ascites. F. Hoffmann at the commencement of the eighteenth century278 gave his full and complete approbation to the operation performed according to the accepted rules. Dominique Anel279 was an avowed partisan of the suction of the effused fluids in the chest. He had seen soldiers very successfully suck, with the mouth, wounds of the chest. He invented different syringes and other machines to pump out the effused fluids, some of which were very large, with canulæ whose orifices were very wide and of different shapes.