PAKACENTESIS. 



383 



canula until the renewed escape of the gas proves that the ob- 

 struction has been removed. If, however, they still fail to find an 

 exit through the canula, a second puncture must be made at a 

 short distance from the first. The wound of the puncture re- 

 quu-es no treatment. 



According to Zundel, enterotomy is comparatively — in ordin- 

 ary cases — harmless; still, however, complications more or less 

 severe are possible, and have been observed. Hemorrhages, 

 though of no alarming nature, have been noticed, and several 

 cases of abscess have been recorded, either at the seat of the 

 operation, or at the wound of the flank, and even in the groin. 

 Peritonitis has also been encountered. Subcutaneous emphysema 

 has been mentioned by Bouley ; but in an experience of many 

 years, we have never seen it. Laceration of the floating colon has 

 been reported by Schaack. As a means of prevention against 

 these accidents we would recommend great care in the introduc- 

 tion of the trocar through the abdominal walls, and especially a 

 condition of thorough cleanliness, with a careful disinfection, of 

 the instrument. 



PAEACENTESIS. 



This term, with its synonyms of puncture and tapping, is at 

 the present time applied exclusively to the operation performed 

 upon the abdominal waUs for the purpose of evacuating the seros- 

 ity collected in the peritoneal cavity, as the result of dropsical ef- 

 fusion. It consists in puncturing the abdominal walls in the man- 

 ner practiced in enterotomy and gastrotomy. The operations are 

 similar, while the purpose varies materially in the several cases. 



This operation had ah-eady been recommended by Vegetius — 

 afterward employed by Vitet, as a last resort in ascitis. Lafosse, 

 Jr., also speaks of it, and in more modern times we find it advo- 

 cated by St. Cyr, Lafosse, Forster and others. Though in the 

 majority of cases forming only a palliative treatment, it is never- 

 theless indicated in chronic dropsy of the abdomen, when all 

 other forms of treatment have failed to produce the resorption of 

 the fluid, especially when its accumulation interferes with the ab- 

 dominal and thoracic functions. In these cases of ascites it has 

 been performed upon horses, cattle and dogs. The injection of 

 tincture of iodine into the peritoneal cavity, after the removal of 



