The Thorax 125 



may be employed. The latter is best, for the reason thait entrance 

 of air into the thorax can be guarded against, arid the flow of 

 liquid being more gradual is less liable to interfere with intra- 

 thoracic pressure and cardiac action. 



The needle should be inserted in a somewhat forward direc- 

 tion at the anterior border of the sixth, seventh, or eighth rib, 

 after first pulling the skin slightly to one side. The intercostal 

 space can be widened by pushing one finger into it. Slight pain 

 is evinced on puncturing the skin. The cavity is reached as soon 

 as resistance to the passage of the needle has ceased. If a canula 

 is used the fluid at first gushes out in a continuous stream, then 

 rh3rthmically synchronous with respiration. During expiration 

 the flow ceases and air rushes in, which must be prevented by plac- 

 ing the finger over the end of the tube after each inspiration. 

 If the flow suddenly ceases it is through plugging by flakes of 

 fibrin, which can be forced back by reinsertion of the trocar. From 

 two to five ounces of fluid should be withdrawn, and the operation 

 repeated daily at a new site of puncture, until no liquid remains. 

 When the effusion shows no sign of abating, Cadiot and Breton 

 advise irrigation of the sac with normal sodium chloride solution, 

 at a temperature corresponding to that of the body. No other 

 or antiseptic solutions should ever be injected. 



BIBLIOGBAPHY. 



Cadiot & Breton — Mfideclne Canine. 



Delafond— Journ. d. M«d. V£t«r. Ttaeo. et Fract. 1829, p. 445. 



Leclerc— Rec. de Med. VMSr. 1886, p. 937. 



Hagnie— Bee. de M6d. Vfitfir. 1870, p. 861. 



Pencb — Cited by Cadiot & Almy in Traits de TtaCr. CMr. d. An. Com. 



Pfelller — Operations Carsas. 



Sberman — American Medicine. Jnne, 1902. 



Thierry — Cited by Cadiot & Almy In Trait6 de Tb6r. Chlr. d. An. Dom. 



Weber — Adam's Woehenschrlft. 1861, p. 64. 



Wm. Koch — Langenbeck's Arctalv. t. kiln. Cbirnrg. 15, p. 706. 



The Heart and Pericardium 



TRAUMATIC LESIONS. 



Not very long ago it was generally believed that a wound of 

 the heart was necessarily if not immediately fatal, but thanks to 

 the experimental researches of Fischer, Kronecker and Schmey, 

 Elsberg, Ricketts, Sherman, and others, we now know that the 

 gravity of a heart wound depends on its size, location, and certain 



