283 Quoted by Sprengel, p. 60, vol. ix.
In the latter part of the eighteenth century there were numerous English and continental writers on the subject of paracentesis. Among them were J. W. Belquer, Sharp Mohrenheim, Richter, Ponteau, Callisen, Pierre Cooper, Allemoth, Zellar, and Audouard. Some of these preferred the trocar to the bistoury. Some were in favor of prompt action, and others objected to the operation unless there were threatening symptoms. Valentin urged that the presence, on the surface of the chest, of oedema and ecchymosed spots was a certain indication of fluid effusion.
During the first twelve years of this century the operation seems to have fallen into disuse. In 1808, Audouard objected to the Hippocratian method, which had been practised for centuries, of drawing out small quantities at a time, for fear that the sudden withdrawal of a large quantity would produce a vacuum in the chest. He maintained, and proved, that sudden and complete evacuation had no such result. In 1811, Corvisart284 drew attention to thoracentesis. In 1812, Larrey discussed its merits. Charles Bell285 preferred the trocar to the other methods in hydrothorax when he could be positive of the presence of fluid, but he stated that he preferred first to introduce the bistoury. He operated in the sixth intercostal space, but in empyema he preferred to make the puncture higher up. Samuel Cooper286 recommended as small an orifice as possible for the evacuation of serum, but larger and wider ones for pus and blood.
284 Maladies du Coeur, 1811.
285 System of Operative Surgery, vol. ii. p. 194.
286 Dictionary of Surgery, p. 749.
In tracing the history of this important operation we have shown that it has been performed from the time of Hippocrates, and that it has been held in different degrees of estimation by the numerous authors who have discussed it—that sometimes it has been popular, and again regarded unfavorably.
Récamier operated, but unsuccessfully. Up to the period we have now reached (1816) great difficulty of accurate diagnosis existed, and crude notions of physiology prevailed. Errors of diagnosis as to the character of the fluid when present, and still more as to its existence in the chest, frequently led to unpleasant results. Laennec's genius so completely cleared up the differential diagnosis of all diseases of the chest, including pleurisy, that men grew less timid. Laennec287 himself was a strong advocate of the operation; he advised it in acute pleurisy where dyspnoea, threatening life, supervened, and in chronic cases where other remedies failed. He proposed to apply a piston cupping-glass over the wound after the discharge of liquid, and to produce a vacuum in the chest more or less quickly, continuously, and completely according to effects.
287 Traité d'Auscultation mediate, 1818.
As Bowditch288 states, "We should be groping in the same dark way, and perhaps getting into the chest by caustic pastes or by actual cautery, had not Laennec discovered for us auscultation, with all its admirable powers of diagnosis of thoracic affections."