CHAPTER XL 



OPERATIONS ON THE THORACIC AND 

 ABDOMINAL WALLS. 



Paracentesis Thoracis (tapping the chest).— Unless ab- 

 solutely necessary, it is not advisable to fix the patient before 

 performing this operation, but to merely have it quietly held 

 in the standing position. Any pressure on the throat or chest 

 is dangerous, and death is very apt to suddenly ensue from 

 asphyxia if the patient struggles or falls heavily to the ground. 

 The operator carefully removes the hair from, and disinfects, 

 a spot about an inch above and behind the point of the 

 elbow on the right side ; a fine trocar and canula are intro- 

 duced subcutaneously for a short distance, and the point 

 passed between two of the ribs (usually the sixth and 

 seventh, or seventh and eighth). The trocar is then with- 

 drawn and the canula inserted as far as necessary, the fluid 

 contents of the chest being allowed to escape slowly. Any 

 material blocking the end of the canula and retarding the 

 flow must be removed by the careful re-introduction of the 

 trocar or a sterilised blunt probe. 



Symptoms of collapse must be watched for, and the amount 

 of fluid withdrawn left entirely to the discretion of the operator. 



Solution of iodine, chinosol, or some antiseptic may or may 

 not be injected, after which the canula is carefully and slowly 

 withdrawn. 



The seat of puncture is dried with aseptic cotton wool and 

 covered with iodoform (or orthoform) and collodion. 



The prognosis of these cases is usually unsatisfactory, as 



