204 PLEURISY. 



the day. If the constitution is much impaired, tonics may be 

 cautiously given, as soon as the violence of the disease is abated. 

 The spirit of nitrous ether is a mild stimulant and a diuretic. 

 Small quantities of gentian and ginger may be added, but the 

 turpentine must not be omitted. 



By auscultation and other modes of examination, the existence 

 f water in the chest is perhaps ascertained, and, possibly, it is 

 increasing. Is there any mechanical way of getting rid of it '' 

 There is one to which recourse should be had as soon as it is evi- 

 dent that there is considerable fluid in the chest. The operation 

 of Paracentesis, or tapping, should be performed ; it is a very 

 simple one. The side-line may be had recourse to, or the twitch 

 alone may be used. One of the horse's legs being held up, and, 

 counting back from the sternum to between the seventh and 

 eighth ribs, the surgeon should pass a moderate-sized trochar into 

 the chest immediately above the cartilages. He will not have 

 selected the lowest situation, but as near it as he could with 

 safety select ; for there would not have been roon between the 

 cartilages if the puncture had been lower ; and the-e would have 

 been injured in the forcing of the instrument betv een them, or, 

 what is worse, there would have been great hazar(i of wounding 

 the pericardium, for the apex of the heart rests on the sternum. 

 Through this aperture, close to the cartilages, the far greater part 

 of the fluid may be evacuated. The operator "»vill now with- 

 draw the stilette, and let the fluid run through tl e canula. He 

 will not trouble himself afterwards about the vvound ; it will 

 heal readily enough ; perhaps too quick, for, <.'()uld it be kept 

 open a few days, it might act as a very useful drain. It should 

 he attempted early. Recourse should be had to the operation as 

 soon as it is ascertained that there is considerable fluid in the chest, 

 for the animal will at least be relieved for a while, and some 

 time will have been given for repose to the overlabored lungs, 

 and for the system generally to be recruited. The fluid will bo 

 evacuated before the lungs are too much debilitated by laboriou<i 

 action against the pressure of the water, and a state of collapse 

 brought on, from which they will be incapable of recovering 

 They only who have seen the collapsed and condensed state ol 

 the lung that had been long compressed by the fluid, can con 

 ceive of the extent to which this is carried. 



Few cases of tapping have been permanently successful, buv 

 the leason has been that they have not been early enough re 

 sorted to. 



If there is fluid in both cavities of the thorax, but one side 

 should be operated on at once, and the other one, the succeeding 

 day. 



There is in pleurisy a far greater tendency to relapse than m 



