1 76 Dropsy of the Thoracic Cavity. 



of the stiletto; then a rubber tube can be fastened to the trochar. This simple proced- 

 ure does, however, not always lead to success, because the exudate rarely stands under 

 sufficient pressure to force the fluid out of the rubber tube. It is therefore frequently 

 necessary to enijiloy the aspirators of Dieulafoy or Potain, which will permit the 

 aspiration of fluid out of the thorax and ofi'er the additional ailvantage of preventing 

 the entrance of air into tiie thoracic cavity. The entrance of bacteria into the 

 thorax during puncture must by all means be prevented because this would lead 

 to a more serious and more malignant inflammation. 



The evacuation of the exudate must always he brought about gradually and 

 slowly in order to avoid sudden changes of the intrathoracic pressure, as these 

 might lead to extensive cajiillary hemorrhages and paralysis of the heart. The 

 puncture must be intorrupte<l at once if the yellowish exudate becomes hemorrhagic, 

 if the patient is attacked by cough or if the needle touches the lung. If the pulse 

 becomes weak the patient should receive a subcutaneous injection of caffeine or oil 

 of camphor. Occasionally one might try intravenous injections of adrenalin (Barr). 

 After the termination of the puncture horses may receive a subcutaneous 

 (Boucheriou) or an intravenous (Almy) injection of 2 or .S liters of physiologic salt 

 solution. Fairise recommends a subsequent intrapleural injection of 1^2 to 4 

 liters of a 1 to 1.5% solution of gelatin in order to prevent hemorrhage or a rapid 

 renewal of the exudate. Subsequent dribbling of the exudate into the intramuscular 

 tissue through the puncture in the thoracic wall may be prevented by the use of 

 a finer trochar. 



The amount of exudate which may be removed by one puncture depends upon 

 circumstances; if there is intense dyspnea, enough should be withdrawn to remove 

 the lattor (in horses 20 to 40 quarts). In cases where the amount of the exudate 

 is moderate and where there is no immediate danger of suffocation, the removal 

 of 4 to 5 quarts in large, and of 250 to 500 cc. in small animals, is sufficient ; 

 larger amounts should be removed at one time only if repeated punctures have 

 shown that additional amounts of fluid have not been formed. It is well known 

 that horses can staml, without damage, the removal, at one time, of 30 to 40 or 50 

 quarts of fluid; however, this may exceptionally lead to the death of the animal, 

 either in consequence of paralysis of the heart (Trasbot, authors' observation) 

 or on account of extensive capillary hemorrhage (authors' observation). These 

 circumstances, as well as the fact that withdrawn fluid may reaecumulate in a 

 short time and so weaken the patient considerably, let it appear advisable not to 

 withdraw very large amounts of fluid at one time. 



Simple puncture is not sufficient in purulent or ichorous 

 pleurisy and it is usually not even successful if the thoracic 

 cavity subsequently is irrigated repeatedly with a disinfecting 

 solution (boracic acid 2-4% ; thymol, 0.1% ; acetate of lead, 

 1-2% ) . Bergeon succeeded in a cow by repeated irrigations with 

 the following solution : tincture of iodine, 60.0, iodide of potash, 

 20.0, boiled water, 10,000 cc. Ordinarily the only procedure 

 that holds out any promise of success is to open the thoracic 

 cavity, and the resection of ribs, followed by cleansing of the 

 chest cavity (Cadeac, Poinot and others). 



Literature. Almy, Bull., 1901, 128.— Aubry, Eev. vet., 1905, 629.— Barr, 

 M. m. W., 1904, 982.— Bergeon, Eev. vet., 1907, 505.— Duvieusart, Eec, 1845, 721.— 

 Eisenmann, Monh., 1906, XVII, 97.— Frohner, ibid., 1905, XVI, 44.— Guittard, 

 Pr. vet., 1908, 1.— Immelmann, Pr. Mt., 1S83, 46.— Kowalewsky, A'et. Jhb., 1906, 

 158.— Lefebre and Guerin, Bull., 1903, 145.— Lienaux, Ann., 1903, 65. — Mathis, 

 J. vet., 1895, 39.— Moussu, Eec, 1906, 153.— Poinot, Eec, 1901, 28.— Pr. Mil. Vb., 

 1899-1908.— Trasbot, Diet., 1889, XVII, 291 (Lit.).— Eec 1892, 425. (See also 

 literature on the primary diseases.) 



2. Dropsy of the Thoracic Cavity. Hydrothorax. 



Hydrothorax occurs as a part of the clinical i)icture of 

 certain organic and general diseases and consists in the collec- 

 tion of a serous fluid in the thorax without inflammatory changes 

 in the pleura. 



