Hydrothorax. 263 



The most successful cases in the horse have been upon young, 

 vigorous animals, from four to eight years old, during the first 

 month of illness, and where the pleurisy has been confined to one 

 side. 



Dr. Bowditch lays down the following rules for the adoption of 

 paracentesis in man {^Clinical Medicine, by Prof. W. T. Gaird- 

 ner) : — 



' ' I now never operate unless I find some distension or rounding 

 out of the chest, and filling up of some of the intercostal spaces, 

 so that the chest presents a uniform curve, and not alternate de- 

 pressions and elevations as in the healthy chest. I operate under 

 the following circumstances when I feel certain there is fluid : 



" I . When there is severe permanent dyspnoea — orthopncea — 

 however acute the disease if I find fluid filling the pleural cavity, 

 or nearly filling it. 



"2. When there are occasional attacks of orthopncea threaten- 

 ing death, even if there be not sufficient to fill more than half of 

 the cavity. If the fluid seems to be the cause of the dyspnoea I 

 operate, because occasionally I have lost a patient while waiting 

 for more extensive physical signs. This rule I apply to acute and 

 chronic cases. 



"3. I use the trochar after three or four weeks of ineffectual 

 treatment, without any absorption being produced. 



" 4. In chronic idiopathic hydrothorax, a latent pleurisy with 

 simply physical signs to indicate extensive effusion, but when the 

 rational signs are either very slight or none at all save a general 

 malaise and weakness. ' ' 



The use of iodide of potassium and vegetable and mineral 

 tonics must be perseveringly employed and the strength further 

 supported b5' a generous diet, to secure the animal against the 

 dangers of extreme prostration, of suppuration, or other undesira- 

 ble conditions of the exuded product. 



Among the dangers attending thoracentesis are fainting as a 

 result of shock on the sudden withdrawal of so much liquid, 

 rupture of the false membranes, and even of the enclosed lung 

 tissue or of blood vessels, under the sudden expansion of the par- 

 tially collapsed lung confined by the investing false membrane, 

 and the introduction of pus or septic germs into the pleural cavity. 

 To obviate the first named dangers tight bands (circingles) around 



