Treatnient. 181 



out by percussion and auscultation. When lung cavities are 

 present, tympanitic and occasionally also metallic sounds are 

 present only in circumscribed places, and tliey are usually sur- 

 rounded by an area of dullness. Diaphragmatic hernia might 

 give rise to errors in diagnosis, if parts of the stomach or loops 

 of intestines have prolapsed into the thorax. But the tympa- 

 nitic or metallic sound which may be present in the posterior 

 and inferior portions of the thorax reaches a high intensity ; its 

 pitch varies with the peristaltic movements and, if these are 

 arrested on account of incarceration, the s^miptoms of intestinal 

 occlusion are present. The character of the fluid which might 

 be present can only be ascertained l)y an exploratory puncture. 



Treatment. In closed pneumothorax, the air ought to be 

 removed. An ordinary trochar is not well adapted for this pur- 

 pose, because more air might be let in by it. Therefore, one has 

 to use a trochar with a stopcock or, still better, a Dieulafoy 

 aspiration apparatus. In the absence of such devices, a simple 

 trochar or hollow needle may still be serviceable if one attaches 

 to it a rubber tube with a clamp. In pneumothorax which opens 

 outward the opening must first be closed. 



The operation recommended for purulent pleurisy might be 

 tried in purulent pneumothorax. 



Literature. Darrow, Eec, 1902, 482.— Deupser, B. t. W., 1890, 321.— 

 Dorsprnng-Zelibo, Vet. Jhb., 1902, 126.— Douville, Eec, 1907, 693.— Fiebiger, Z. 

 f. Tm., 1902, YI, 1.— Gheorghiardi, Ann., 190.5, 153.— Marek, Z. f. Tm., 1905, IX, 54.— 

 Moussu, Eec, 1897, 81, 558.— Petit, Eec, 1902, 21.— Siedamgrotzky, S. B., 1887, 71.— 

 Sperling, D. t. W., 1898, 270. 



Hematothorax. The presence of pure blood in the chest cavity is 

 called hematothorax, in the limited sense of the word. However, those 

 cases are frequently included where a serous or purulent exudate or 

 transudate are more strongly stained with blood. Such hemorrhages 

 occur after intense infections, in exhansting diseases, in conse(|uence of 

 rupture of vessels in the thoracic cavity or after external traumatic 

 injuries. 



The symptoms simply point to an accumulation of fluid in the 

 thorax. The detection of its hemorrhagic character is only possible by 

 exploratory puncture. One may, in addition, observe the symptoms of 

 an acute anemia, which correspond in degree with the amount of blood 

 lost. 



The treatment depends on the primary disease and tlie cause of the 

 affection. Small amounts of blood may be completely absorbed. 



