226 
PROGNOSIS AND TREATMENT OF THORACIC INJURIES. 
to injury of the lung, though its absence does not establish the 
contrary. 
(4) The passage of air through the wound during breathing is strong 
evidence of a penetrating wound of the chest; but, as above stated, 
passage of air, as well as emphysema of neighbouring parts, occur in 
some non-penetrating wounds of large extent. 
(5) Pulmonary prolapse sometimes occurs after large openings in the 
thoracic wall, and the piece of lung is liable to be strangulated and 
become necrotic. 
(6) If these observations do not determine whether the wound is a pene¬ 
trating one, and it is considered absolutely necessary to determine the ques¬ 
tion rather than to leave it uncertain and merely to adopt the treatment 
usual in penetrating wounds, the parts may be disinfected, and further 
examined with the aseptic finger or probe. In default of an accurate 
diagnosis, it is, however, better to adopt the treatment for a penetrating 
wound. Bleeding vessels should be ligatured, and any fragments of 
broken ribs replaced under antiseptic precautions. 
Animals with such wounds sometimes bend the hind-quarters instinc¬ 
tively towards the injured side, and thus prevent the wound gaping. 
Prognosis. Every penetrating wound of the chest should be viewed as 
a possibly fatal injury, but all do not necessarily take a fatal course. 
They are more grave in horses than in cattle, but less so in carnivora. 
The prognosis chiefly depends on whether or not pneumothorax or 
hsemothorax exists and pleurisy seems imminent. According to general 
experience, the risk of pleurisy is greatest in horses. When thoracic 
wounds are of a serious character, most horses require to be supported 
in slings, otherwise they sometimes die in two or three days. Incised 
wounds produced by scythes or lances heal more easily than penetrating 
bruised wounds made by manure-forks or the tines of harrows. Com¬ 
plications materially affect prognosis; pneumothorax, hgemothorax, or 
pleurisy is unfavourable. Moderate fever from wound infection does not 
necessarily prevent recovery, but symptoms of pleurisy generally 
forebode death. 
Numerous recorded cases testify that such injuries in animals some¬ 
times take an unexpectedly favourable course. Jacobin records the 
satisfactory recovery of a horse from a penetrating wound caused by a 
spur, which had perforated the thoracic wall and injured a rib. Recovery 
is not impossible even in cases in which the finger can be introduced 
into the pleural cavity, and the movement of the lung distinctly felt. 
Thus Thieily descubes a case of shot-wound, with prolapse of the lung 
thiough the thoracic opening, in a sporting dog. Recovery occurred 
in three days. Esvelt saw a horse whose chest had been penetrated by 
a carnage pole between the 11th and 12th ribs. There was prolapse 
