Purulent Pleurisy (^Empyema) in Solipeds. 341 



source from whicli the infection proceeded, and the evacuation 

 and disinfection of the pleura invaded. Beside the treatment of 

 the preexistent and predisposing disease or injury, any injury to 

 the walls of the thorax must be treated so as to evacuate all pus 

 germs or other septic material at the earliest possible moment. 

 Deep penetrating wounds must be probed, given free dependent 

 drainage and packed with antiseptic gauze or subjected to anti- 

 septic injections several times a day, Phlegmonous inflamma- 

 tions and forming abscesses are to be opened early and a free out- 

 let allowed for the pus which might burrow onward toward the 

 pleura. Disinfectants must be freely used : mercuric chloride 

 (i : 1000) when the drainage is free ; in case of a very extensive 

 cavity a 5 per cent, solution of creolin or lysol may be used. In 

 all such cases it is to be considered that it is not the antiseptic 

 alone that proves effective. The protective action of the tissue 

 and blood leucocytes and of the embryonal cells multiplying in 

 the affected tissues is of itself sufficient to deal successfully with 

 a slight local invasion, and our assistance in the way of antisep- 

 sis is to limit and prevent the dangerous excess of the invading 

 microbes. In caries of a rib, resection may be demanded, con- 

 ducted with similar antiseptic precautions. 



When, on the other hand, empyema is already present the 

 evacuation of the liquid from the pleural sac is the first considera- 

 tion. This may be accomplished by aspiration, by the cannula 

 and trochar or by simple incision and drainage. In all aUke the 

 greatest care must be taken in the disinfection of the skin in the 

 seat of incision or puncture, of the hands of the operator, and of 

 the instruments. We are dealing with an already infected part 

 but it is possible to add other and even more deadly infections to 

 the already existing ones. Shave the surface, wash thoroughly 

 with soap and boiled water, then douche with mercuric chloride 

 solution ( I : 500) . Deal with the hands in the same way and 

 boil all instruments. The incision must be at the front of the 

 ninth rib close to its union with its cartilage, and, to avoid pos- 

 sible risk of striking the diaphragm, the point of the aspiration 

 needle or trochar may be directed forward and upward after it 

 has passed through the intercostal muscles. Having drawn off 

 the septic or purulent fluid, the pleural cavity may be washed 

 out with a saturated solution of salicylic acid or a 3 per cent. 



