THORACOCENTESIS 55 



canula will give a larger percentage of shock cases than one 

 of smaller caliber. 



Treatment. — Shock is prevented by a slow, gradual evac- 

 uation of the fluid. The evacuation should be so gradual as 

 to leave no impression that would tend to disturb the equilib- 

 rium of the general circulation. In a pronounced case, in- 

 ternal treatment is of little service. Warm clothing, ammo- 

 niacal stimulants, intravenous and subcutaneous salt solu- 

 tions, are among the expedients to be tried. 



Refilling of the Thorax. — Thoracocentesis is not often ef- 

 fectual because it attacks only an effect. The cause is often 

 still active. If the disease is due to inflammation of the 

 pleura, as is generally the case, the inflammation, not being 

 benefited by the operation, will again proceed to refil the 

 pleural sacs. This refilling will occur rapidly in acute cases 

 and slowly in the chronic ones. In the latter when the inflam- 

 matory process is on the verge of resolution and fails to fill 

 the cavity with exudates faster than the pleura absorbs them, 

 convalescence will follow soon after the operation! But if 

 the exudation exceeds the absorption, a refilling, one twp. 

 three or even five weeks later will occur, according to the ac- 

 tivity of the process. 



In true hydrothorax, that is non-inflammatory hydrotho-' 

 rax, the refilling will follow in strict obedience to the nature 

 of the primary lesion. 



Treatment. — The task of preventing refilling of the 

 thorax is that of curing the caustive disease — the pleuritis. 

 The success of the operation in permanently restoring the 

 health, depends upon the possibility of restoring the ple'ura 

 lo its normal condition. This must be done largely through 

 treatment that will restore the lost vitality. Good supporting 

 food, abundance of fresh air, invigorating, out-door exercise, 

 sun-baths, cheerful surroundings and a medication of strych- 

 nia, quinine and bitter tonics, is a combination of treatments 

 that must not be omitted. Ferruginous tonics in the form of 

 small doses of tincture chloride of iron well diluted are also 

 helpful. The emunctories must not be neglected. Frequent 

 doses of oil of linseed to keep the bowels in a state of activity, 

 digitalis to promote diuresis and warm clothing to maintain 

 a normal activity of the skin are appropriate lines of treat- 

 ment in this connection. 



Pleural Adhesion. — The cessation of the inflammation of 

 the pleura sometimes occurs only after more or less extensive 

 fibrous adhesions have formed between its parietal and vis- 

 ceral portions. These may be limited or they may be dif- 



