REPORT OF TEN CASES OF PLEURITIC EFFUSION 
WITH ASPIRATION OF THE CHEST-FOURTH SE- 
RIES-WITH A CASE OF INJECTION OF CARBOLIZED 
IODINE INTO A LUNjU CAVITY. 
BY F. PEYRE PORCHER, M. D., ONE OF THE PHYSICIANS TO CITY 
HOSPITAL, CHARLESTON. 
This series extends the record to fifty-four cases. It may be 
significant that it should fall to the lot of one physician to en- 
counter so many cases; but if this be only a fatality, it is very 
curious, for they occurred, for the most part, in an annual ser- 
vice of only four months, and in only one division of a hospital 
of no great capacity. They arc published to illustrate a prob- 
lem, and incite to reflection; for if it be not a fatality, and the 
same proportion fell to all those occupying a like position, as 
well as to others throughout the length and breadth of the 
land, then our estimate of the frequency of such cases must be 
enormously increased, and they must almost rival the sands of 
the seashore in multitude. If they do exist in such numbers, 
but unhappily are not recognized, and if paracentesis is fre- 
quently essential to the relief of the dyspnoea, pain and com- 
pression of the lungs, or is resorted to merely to prolong life, 
what must be the sufferings of the people without it? Some 
lines by a Latin poet are recalled, which, if the above surmises 
can by any possibility be correct, we suggest as a suitable in- 
scription to be placed over the portals of hospitals : 
* * * crudelis, 
Ubique luctus, ubique pavor, 
• Et plurima mortis imago! 
The hospital cases are for the most part derived from the 
records furnished by the house physicians-Drs. Buchanan, 
Howe, Hill and Carn-but very much curtailed and condensed 
pi their recital here. Of these, reported seven. 
Case I.-J no. McCoy, colored, soft 26x admitted October 2d, 
1887. Paracentesis of the right made "a little an- 
terior to the anterior fold of the Tn this case there 
was chronic pleuritis with thickening of the lung tissue, fric- 
tion fremitus, spitting of blood, diarrhoea andhemaciation. The 
right infra-clavicular region was dull and sunken. The collec- 
tion of fluid was isolated, of limited amount, aad collected in 
pockets, and which was removed on two separate occasions- 
after some difficulty in finding the exact location of the fluid. 2 
Aspiration of the Chest-Porcher. 
The relief was partial. At the autopsy the right lung was 
carnified, with adherent pleurae; and death, which was inevit- 
able, occurred from perforation of the intestines from extensive 
tubercular disease. 
Case II.-Geo. Jenkins, colored, aet. 25, had been in the hos- 
pital for some months for a lacerated wound of the thigh which 
bad healed. He did not seem to gain strength, and had what 
was thought to be hectic fever. 
Being transferred to the medical wards, it was ascertained 
that the left cavity of the chest was filled with fluid. The 
dyspnoea becoming excessive ; on December 10th, a pint of 
serum was aspirated "with the happiest results," the dyspnoea 
being relieved. The patient was subsequently transferred. 
Case III.-L. Clinton, colored, set. 65, admitted August 11th, 
an insane patient employed as a laborer, but admitted to med- 
ical wards as he suffered from dropsy, commencing in the lower 
extremities and extending upwards. He was addicted to tak- 
ing caustic potash slightly diluted, which he persisted in up to 
the time the swelling appeared, which was ascribed to the 
effects of the caustic upon the kidneys. Large quantities of 
serum were drained from the scrotum by repeated puncture 
with needles. 
The right chest was aspirated by Dr. Porcher, and about 80 
ounces of serum removed. This was repeated September 17th 
with the withdrawal of 64 ounces. 
The effects of calomel, squills, jaborandi and supertartrate of 
potash were tested. 
Death occurred September 25th. The autopsy revealed the 
existence of general anasarca, hydrothorax, an enormously hy- 
pertrophied heart with the aorta dilated, and concretions upon 
its valves. The kidneys were contracted, filled with cicatrices 
and covered with numerous small cysts " supposed to be due 
to the long and continued use of concentrated lye." which, by 
the report of the house physician, had been kept up for years. 
Case IV.-Jas. Pleasant, colored, set. 21, admitted July 19th, 
with a diagnosis of tuberculosis and pleuritic effusion. Dr. 
Porcher aspirated a small amount of serum from the right 
pleural cavity and the patient seemed to improve after taking 
cod liver oil, etc. He left the hospital without permission, and 
was lost sight of. 
Case V.-S. Cash, colored, mt. 27, admitted July 8th. Kight 
pleural cavity filled with serum. A small quantity was removed 
July 19th by the hypodermic needle with the view of promot- 
ing absorption. He was also given iodide of potash. 
His condition as reported by the house physician (Dr. Carn) 
was very favorable-when he escaped from the hospital to 
avoid a return to the prison from which he had been removed. 
Case VI.-E. Gardner, colored, female, set. 19, admitted July 
4th, with a diagnosis of continued fever; but a careful exami- Aspiration of the Chest-Porcher. 
3 
nation revealed a broncho-pneumonia with pleuritic effusion 
on left side. A small quantity of serum was removed with the 
hypodermic syringe, and she was given quinine in small doses. 
''Four days after operating," as reporetd by the house phy- 
sician, Dr. Carn, " the portion of lung which had been discov- 
ered to be dull, became perfectly resonant; the patient recov- 
ered from febrile symptoms and was discharged some days 
later in perfect health." 
This supports the experience of myself and others, that in 
fair cases the removal of small quantities of fluid is often high- 
ly beneficial in promoting absorption. 
Case VII.-W. M. Bradford, white, set. 40, admitted Nov. 
Sth, on a permit of chronic hepatitis. His lowTer extremities 
were swollen and there was great dyspnoea, so that he could not 
sleep in the recumbent posture, but there was no albumen in 
the urine. A variable murmur was heard in the mitral region, 
though the pulse was characteristic of aortic regurgitation. 
il Dr. Porcher, after careful examination, decided that there 
was enlargement of the liver, with pleuritic effusion."'- Two 
pints of straw-colored fluid were drawn from the right pleural 
cavity, which gave great relief, the patient afterwards passing 
from the care of the house physician who reported the case. 
Case VIII.-M. Gargat, Frenchman, set. 49, readmitted May 
29th, 1887, had been for many months previously in the hospi- 
tal, suffering from excessive dyspnoea, " with a diagnosis of 
mitral obstruction and aortic regurgitation." For months he 
could not lie in bed, but was always propped in a chair, and he 
presented an extraordinary example of prolonged pain and 
suffering. 
Dr. Porcher examined the patient, but the heart sounds were 
so masked, tumultuous and irregular, with persistent weakness 
of pulse, but with very little albumen in the urine, that it was 
impossible to verify the above diagnosis. He decided, however, 
from the bulging of the intercostal spaces, the extensive dul- 
ness, etc., that pleuritic effusion also existed. A portion of the 
irregularity and weakness of the heart murmurs was ascribed 
to the inhibitory influence of the extensive effusions, "and for 
the first time (July 5th) the operation of paracentesis thoracis, 
with Fitch's dome trocar, was performed on the left side below 
the angle of the scapula, and 24 ounces of fluid were removed, 
with so much benefit that he was discharged " He could walk 
about freely and lie down with comfort. 
He was re-admitted October 6th, with a bilious attack-the 
old troubles having also returned ; there was loss of appetite, 
excessive dyspncea, inability to lie down, great pain over the 
heart, and swelling of the lower extremities. In this distressing 
condition, and after exhausting all the usual resources, it became 
necessary to resort again to the aspiration. Three pints of 
fluid were taken from the right cavity, which gave relief for 4 
Aspiration of the Chest-Porcher. 
some weeks, when death became inevitable. The tinctures of 
digitalis and strophanthus, and nitrite of amyl were used con- 
currently at intervals. 
Autopsy.-At the autopsy, which was performed with great 
care, pericardial adhesions existed, and both pleural cavities 
were found still to contain a large amount of fluid ; both 
lungs were consolidated by the pressure of the fluid-with very 
little in the pericardial sac. The right heart was greatly di- 
lated, and there was apparent insufficiency of the tricupsid 
consequent thereto. Hypertrophy slight. The mitral valves 
were diseased and vegetations encrusted the aortic valves, 
which were hard and almost calcified. It was interesting to 
observe the excessive dilatation of the pulmonary artery, 
which resembled the aorta in size. Its valves were perfect. 
Case IX.-J. M., white, aged 22. This case of excessive em- 
pyema of the thorax, I was invited to see with a friend, whom 
I assisted in aspirating the chest, with partial success. The 
purulent accumulation was so excessive that it forced a pas- 
sage through the intercostal spaces, infiltrating the chest walls, 
and the patient may almost be said to have been deluged with 
pus. Under supportive and other measures he survived for 
some weeks. 
Case X.-This occurred in a white youth, set. 16, under my 
care in this city. The right cavity was found to be almost 
filled with fluid. A small quantity being aspirated, by the 
irritability set up, aided by iodide of potash, muriate of ammo- 
nia and diuretics, absorption was slowly produced. 
Case XI.-S. Fisher, colored, act. 18, admitted July 25. Diag- 
nosis: tuberculosis and pleuritic effusion in both cavities! 
This was an example very rare, we may be allowed to say, of 
complete failure in diagnosis; but it is recorded to show how 
this may occur. No fluid was found upon two aspirations, but 
the use of the needle was followed by no ill effects. The error 
was owing to the fact that the lungs were in a state of cancer- 
ous degeneration, due to tuberculosis; there was complete dul- 
ness and every sign of the existence of fluid. So conclusive 
did they appear that it was the first case that a preliminary 
use was not made of the hypodermic needle to test for the pres- 
ence of fluid. 
Case XII.-Injection Into a Lung Cavity :-This case was 
interesting as it at least demonstrated that very slight disturb- 
ance, either local or general, may result from such a procedure. 
M. White, colored, let. 35, admitted July 10th, suffered from a 
phthisical abscess in the left lung, with cough, purulent expec- 
toration, night sweat, and other symptoms of well-marked pul- 
monary disease. 
The cavity was single and so extensive and well defined as 
to render it extremely suitable for this form of treatment. Aspiration of the Chest-Porcher. 
5 
The formula* recommended by Dr. Blake White, of New 
York, was employed-using also his needle attached to a hypo- 
dermic syringe filled with the fluid. This was injected into the 
left lung about two inches below the clavicle, and the same dis- 
tance from the left border of the sternum. When the point of 
the needle passed in and touched the posterior wall of the cav- 
ity the resistance was easily felt, and we could be certain of 
the success of the operation. 
With the exception of some cough, there was so little irrita- 
tion, pain or uneasiness produced, that the patient was not de- 
terred from going almost immediately to a meal. Nearly every 
disagreeable symptom was relieved and the cough greatly di- 
minished. The operation was repeated after six weeks, but 
did not arrest the final advance of the disease, though the pa- 
tient survived several months. 
A similar case is reported with a previous series. 
*Ti. Atropia gr. 
Morpia Sulph gr. iv. 
Tinct Iodine 5 
Acid. Carbolic, (pure) gtt. xx. 
Glycerine 5 s s • 
Dil. Alcohol, 20 to 30 ct ,5 8 s • 
M. Sig.-15 to 30 minims.