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19 September 1866: Consciously breaking with medical tradition, Clifford Allbutt, physician, and Claudius Galen Wheelhouse, surgeon, cooperate at Leeds Infirmary to cure a pericarditis

Medical Times and Gazette. 1866/11/03. Case of Paracentesis Pericardii – Recovery – Clinical Remarks (under the Care of Dr Clifford Allbutt) Get it:

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Excerpt

C. S., aged 25, gas-pipe layer, was admitted on September 18, 1866. On admission he was suffering from very acute rheumatism, both muscular and arthritic, and there was considerable dyspnoea and oppression. On examination the pericardium was found to be much distended with fluid, and there was acute pain in the region of the heart. A blister over the heart was ordered, and full alkaline and opiate treatment. On September 19 Dr Allbutt was hastily summoned to see the patient, who was found sitting up in bed, with his elbows on his knees, struggling for breath. He was covered with a cold copious sweat. The area of pericardial dullness was found to be considerably increased, occupying nearly the whole of the left chest in front. There was perfect resonance all over the left lung behind. The patient was clearly at the point of death, and Dr Allbutt determined at once to ask Mr Wheelhouse to tap the pericardium. The extent of the pericardial dullness was now accurately defined, and the probable position of the apex of the left ventricle and of the auricle was as far as possible ascertained. Mr Wheelhouse determined to open the sac half an inch from the sternum on the left side and opposite the upper margin of the costal cartilage of the fifth rib. He passed in a fine trocar, inclining it slightly upwards and inwards, so as to enter, if possible, opposite the centre of the left ventricle. He pushed it onwards until he could distinctly feel the movements of the heart with the instrument; and then, sheathing the point, he pushed the canula well up to the heart until he could both feel and see the impulse. The trocar was then wholly withdrawn, and the fluid allowed to escape. This it did in a steady stream at first, which soon subsided into a saltatory flow coincident with the heart’s contractions. During the operation the patient gradually obtained relief, and after the canula was withdrawn, the bed rest was removed, and he was able to lie down. Dr Allbutt pointed out how strong an instance was to be seen in this case of the unity of the medical art in all its aspects. He said that no case could show more clearly how necessary it is for the physician to have a useful knowledge of the resources of the surgeon, and for the surgeon to be able at once to perceive the wants of the physician. Nothing, in his opinion, was more to be regretted than the unfortunate division of these two great departments of the healing art, by which a mere arrangement of convenience has been placed on the level of a real distinction, thereby encouraging at the very outset of a student’s career a narrowness of thought and an incompleteness of education, which is most mischievous to the best interests of the profession.

To facilitate reading, the spelling and punctuation of elderly excerpts have generally been modernised, and distracting excision scars concealed. My selections, translations, and editions are copyright.

Abbreviations

Comment

Comment

This theme remained with him: “Physic,” he said in 1904 “is sterile in proportion to its divorce from surgery” (Rolleston 1929).

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