PREVENTION, SYMPTOMS AND TREATMENT 203 



sirable. If the effusion is large, or persists for several weeks, no 

 hesitancy must be felt as to removal of the effusion by puncture. 

 There is practically no danger when it is done aseptically and much 

 damage accrues to the lung by long continued effusion. In the 

 horse, puncture by a sterile trochar and canula is done in the 8th or 

 9th intercostal space at the anterior margin of the rib (to avoid 

 the artery) and a few inches above the lower border of the lung. 

 The hair must be clipped off this area and the dry skin thoroughly 

 painted with tincture of iodine. The instruments should be boiled. 

 All the fluid should not be removed if weakness of the pulse or 

 violent coughing occur, and the removal of the fluid should be slow. 

 The puncture may be covered with plaster or collodion, and it is 

 wise to incise the skin and not puncture directly under the incision 

 — but to one side. Following puncture, or in the later stages of 

 pleurisy, the administration of potassium iodide (H., 3ii; D., gr. x, 

 twice daily), together with tincture of ferric chloride (H. & C, §i; 

 D., Tllx), and bitters — as fluidextract of nux vomica (H. & C, 3i; 

 D., HT,i-ii) — promote recovery. The food must be highly nutri- 

 tious; milk and eggs to large animals, and bovinine and beef juice 

 with milk and meat for dogs, are indicated. 



Chronic Pleurisy. — In chronic pleurisy with effusion the 

 treatment is practically as outlined above, and, in the dry form, treat- 

 ment is unavailing (tuberculosis). 



Empyema, or purulent, pleurisy, following various general in- 

 fections — as pneumonia, tuberculosis, and injury of the chest with 

 local infection — always demands immediate operation. The per- 

 sistence of chills and fever and the character of the aspirated fluid 

 enables one to make a diagnosis. 



Puncture is rarely sufficient, but there must be resected a por- 

 tion of one or more ribs to facilitate drainage. Cure is attained by 

 obliteration of the suppurating cavity and adhesion of the pul- 

 monary and parietal pleural surfaces. In selecting the site for 

 operation one must choose the lowest point to secure efficient drain- 



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