284 PLEURISY. 



The 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 determined. Warm and comfortable clothing 

 cannot be dispensed with in pleurisy. 



The sedative medicines, however, should be omitted much sooner than in 

 pneumonia, 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 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 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 forcing 

 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. Through 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 through the canula. He will not trouble him- 

 self afterwards about the wound ; it will heal readily enough ; perhaps too 

 quickly, for, could it be kept open a few days, it might act as a very useful 

 drain. It should 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 debi- 

 litated 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 of the lung that had 

 been long compressed by the fluid, can conceive of the extent to which this is 

 carried. It should be added — a fact important and alarming — that the 

 records of veterinary surgery contain very few cases of permanently successful 

 performance of the operation. This should not discourage the practitioner 

 from attempting it, but should induce him to consider whether he may not 

 perform it under happier auspices, before the lungs and the serous membrane 

 which lines the cavity have been too much disorganised, and the constitution itself 

 sadly debilitated. There could not be any well-founded objection to an earlier 

 resort to paracentesis, and he must be a bungler indeed who wounded any 

 important part. 



It should he ascertained by auscultation whether there is fluid in both cavi- 

 ties. If there should be, and in considerable quantity, it will not be prudent 

 to operate on both sides at once. If much fluid is discharged, there will be 

 acceleration and difficulty of respiration to a very great degree. The practi- 

 tioner must not be alarmed at this ; it will pass over, and on the next day he may 

 attack the other side ; or open both at once, if there is but little fluid in either. 



