540 PLEURISY. 



be found of benefit in all those cases where debility follows the 

 subsidence of more acute symptoms. 



In those cases of subacute pleurisy, or, indeed, in any form 

 where the liquid effused into the pleural sac or sacs — hydro- 

 thorax — does not become lessened or removed by absorption 

 after a reasonable length of time has been alloAved to transpire 

 for the restorative powers of the system to come into opera- 

 tion, assisted by the aids which we may have supplied, and 

 when the amount of the eftused material is such as to interfere 

 with the respiratory function, the question of instrumental 

 interference for its removal comes into operation. 



Although it can hardly be considered a prudent practice, 

 whenever we may be satisfied of the presence of liquid in the 

 chest as the result of disease, to have recourse at once to punc- 

 turing the cavity with a view to its removal, there is also the 

 opposite extreme into which we may fall, that of delaying the 

 performance of the operation until the strength of the animal 

 is so much reduced that collapse is almost certain to follow. 

 The operation itself is a simple one, but is not invariably 

 successful, rather the opposite ; it may be that it is often too 

 long delayed, or that, the cause upon which the exudation was 

 dependent still existing, the removal of the adventitious 

 material is followed by the outpouring of more. From what 

 I have observed of this condition in the horse, I feel disposed 

 to think that we are oftener too hasty than remiss, and that in 

 all cases a fair trial for three or four weeks ought to be given 

 to well-considered remedies ere the operation is performed. By 

 some who have employed them, powdered cantharides from 

 four to ten grains, Avith digitalis twenty to thirty grains, and 

 nitrate of potash two drachms, made into ball, and given twice 

 daily for a week, or alternated with a ferruginous tonic, have 

 been highly spoken of 



The conditions, general and local, to which we ought to have 

 regard in directing us whether or not we ought to resort to 

 this operation — paracentesis thoracis — and the stage of the ill- 

 ness when it should be carried out, are — (1) That the dyspnoea 

 which exists depends upon the presence of fluid in the pleural 

 sac, that it is dangerous in its extent, and that it is disposed to 

 increase ; (2) That all ordinary means, dietetic and therapeutic, 

 have failed to relieve the distressing symptoms ; (3) That the 



