THORACOCENTESIS 51 



of pleurisy, but it is in the soliped that the condition is most 

 frequently recognized early enough to render surgical treat- 

 ment effectual. The condition calling for aspiration becomes 

 apparent at the end of the usual course of pleurisy, when -the 

 patient, instead of convalescing, remains mysteriously in- 

 disposed. The fever continues; the appetite is variable; the 

 strength wanes slowly; the respirations, already slightly ac- 

 celerated, become more and more labored day by day; the 

 general Condition becomes more emaciated ; frequently a 

 marked oedema develops between the fore legs ; the eyes be- 

 come glassy, staring and anxious ; and auscultation reveals 

 an absence of vesicular murmur up to a level that is equal on 

 both sides of the chest. These symptoms develop rapidly or 

 slowly in obedience to the activity of the inflammatory pro- 

 cess. The filling process may run a course of one week, two 

 weeks, three weeks or even five weeks, before the symptoms 

 reach the maximum intensity. In rare cases three months 

 of mysterious ill-health following acute pulmonary inflamma- 

 tions is finally accounted for by the appearance of symptoms 

 which point to hydrothorax. 



The prognosis depends upon the rapidity of the filling 

 process. As already mentioned, the rapid filling up of the 

 pleural sacs during the acute stage of broncho-pleuro-pneu- 

 monia or simple uncomplicated diffused pleurisy, is an un- 

 favorable condition. It is generally fatal. But when the ac- 

 cumulation is less rapid the condition is often amenable to 

 treatment. The sub-acute and the chronic cases very fre- 

 quently, recover under energetic surgicaland medical inter- 

 ference, and are therefore the favorable indications for the 

 operation. The character of the exudate has also an im- 

 portant bearing upon the prognosis. If composed of pure 

 serous fluid, especially if the accumulation has been slow, a 

 favorable result may be expected ; but when purulent or hsem- 

 orrhagic and especially if the accumulation was more or less 

 rapid, there will be but little chance for recovery. 



EQUIPMENT. — i. Trocar and canula. 



2. Scissors. 



3. Razor. 



4. A yard of small rubber tubing. 



5. A small quantity of antiseptic solu- 



tion. 



6. An empty pail. 



Restraint. — The operation is performed in the standing 

 position, under no other restraint than that of holding the 

 patient along the side of the stall to prevent moving about 



