PLEURISY. 219 



cultation. There will be the cessation of the respiratory murmur at the sternum, and 

 the increased grating — not the crepitating, crackling noise as when congestion is going 

 on — not the feebler murmur as congestion advances ; but the absence of it, begiiuiinL 

 from the bottom of the chest. 



It is painfully interesting to watch the progress of the effusion — how the stillness 

 creeps up, and the murmur gets louder above, and the grating sound louder too, until 

 at length there is no longer room for the lungs to play, and suffocation ensues. 



The fluid contained in the chest varies in quantity as well as appearance and con- 

 sistence, ^lany gallons have been found in the two sacs, pale, or yellow, or bloody, 

 or often differing in the two sides of the thorax ; occasionally a lliick adventitious coat 

 covering the costal or the pulmonary pleura — rarely much adhesion, but the lungs 

 purple-coloured, flaccid, compressed, not one-fourtii of their usual size, immersed in 

 the fluid, and rendered incap.ible of expanding by its pressure. 



Here, as in pneumonia, the bleeding should be prompt and copious. Next, and of 

 great importance, aperient medicine should be administered — that, the effect of which 

 is so desirable, but wiiich we do not dare to give when the mucous membrane of tlie 

 respiratory passages is the seat of disease. Here we have to do with a serous mem- 

 brane, and there is less sympathy with the mucous membranes of either cavitv. 

 Small doses of aloes should be given with the usual fever medicine, and repeated 

 morning and night until the dung becomes pnltaceous, when it will always be pru- 

 dent to stop. The sedative medicine is that which has been recommended in pneu- 

 monia, and in the same doses. Next should follow a blishr '^n the chests and sides. 

 It is far preferable to setons, for it can be brought almost iiif > '• 'ntact with the inflamed 

 surface, and extended over the whole of that surface. An airy, but a comfortable box, 

 is likewise even more necessary than in pneumonia, and the practice of exposure, 

 uncovered, to the cold, even more absurd and destructive. 'I'he blood, repelled from 

 the skin by the contractile, depressing influence of the cold, would rush with fatal 

 impetus to the neighbouring membrane, to which it was before dangerously deter- 

 mined. Warm and comfortable clothing cannot be dispensed with in pleurisy. 



The sedative medicines, iiowever, should be omitted mncli sooner than in pneumo- 

 nia, and succeeded by diuretics. The common turpentine is as good as any, made 

 into a ball with linseed meal, and given in doses of two or three drachms twice in 

 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 of effusion 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 evident that there is considerable fluid in the chest. The operation of Fnraccntesis, 

 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 sur- 

 geon should pass a moderate-sized trochar into the chest immediately above the car- 

 tilages. He will not have selected the most dependent situation, but as near it as he 

 could with safety select; for there would not have been room between the cartilages 

 if the puncture had been lower; and these would have been injured in the forcino- of 

 the instrument between them, or, what is worse, there would have been great hazard 

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

 this aperture, close to the cartilages, the far greater part of the fluid may be evacuated. 

 The operator will now withdraw the stilette, and let the fluid run throuoh the canula. 

 He will not trouble himself afterwards about the wound ; it will heal readily enough; 

 perhaps too quick, for, could it be kept open a few days, it might act as a very useful 

 drain Tfshould be 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 

 overlaboured lungs, and for the system generally to be recruited. The fluid will be 

 evacuated before the lungs are too much debilitated by laborious 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 



