132 Surgical Diseases and Surgery of the Dog 



through the skin and pectoral muscles along the border of the 

 sternum from the third to the sixth ribs. The broad origin of the 

 serratus anticus major muscle is dissected, and the third, fourth 

 and fifth ribs divided beyond the course of the internal mam- 

 mary artery, and the intercostal muscles carefully severed. The 

 edges of the wound must then be retracted, or about an inch of each 

 rib may be removed. The intact pleura is now observed. All 

 bleeding being absolutely stilled, the pleura is incised along the 

 course of the wound. At the same moment the lung collapses and 

 respiratory efforts become labored. At this point artificial respira- 

 tion must be started up. The pericardial sac is quickly grasped, 

 drawn up into the wound, sutured to the muscles round the edges 

 of the thoracic wound, and opened by longitudinal incision. There 

 is no bleeding from the pericardium. The heart is brought up into 

 the opening in the chest wall by means of two long traction sutures 

 inserted on either side of the wound, and carried deep into the 

 ventricular wall, such manipulation in no wise interfering with its 

 function. Bleeding from the wound can be immediately stopped 

 by crossing the sutures and holding them taut. The permanent 

 sutures of silk are next placed, and these should be continuous, 

 superficially inserted and tied during diastole, the knots being firmly 

 secured. The next step is to make a complete toilet of the sac. 

 The latter is then closed by continuous silk suture, the chest wall 

 is sutured, including the divided muscular tissues, and finally a 

 subcuticular suture is inserted in the skin. The bellows should be 

 forcibly blown up just as the chest is closed, in order to expel all 

 the air possible. Natural respiration shortly recurs, the bellows are 

 withdrawn, and the tracheotomy wound closed. 



PEBIGARDIGENTESIS. 



This operation is resorted to whenever extinction of life is 

 threatened through distension of the sac by effusion, or when 

 secondary hydropsies have developed. There is little or no danger 

 attending it, as Elsberg has shown in his experiments that needle 

 punctures are always small, and though there is slight hemorrhage, 

 which is more considerable in the auricles than in the ventricles, it 

 soon ceases, and is never enough to endanger life. 



The operation should be performed with an aspirator provided 

 with a short needle of minute caliber thoroughly sterilized. Em- 



