248 
PUNCTURE FOR EMPYEMA. 
relieving compression of the lungs, and improving conditions for 
absorption. 
(2.) Puncture of the Thorax for Removal of Purulent Fluid.— 
Thoracic puncture for purulent or putrefactive collections, or for abscesses 
in the lungs, is not often employed, and rarely proves successful. The 
procedure is the same as in pleuritic effusion, particular attention being 
paid to antiseptic precautions. Exploratory punctures may sometimes 
be needful for diagnosis. 
After complete removal of the contents, it may be desirable to wash 
out the cavity, or the abscesses between the layers of the pleura, or in 
the lung. For this purpose Lafosse used aromatic fluids. Hoffmann 
employed the tube used for carrying off the fluid, for introducing into the 
thorax chloride of sodium, *5 per cent.; sublimate 1 in 5,000; carbolic 
acid *5 per cent., or concentrated salicylic acid, or thymol solutions, 
warmed to 98° Fahr. What success was attained is not recorded. In 
man, an incision is sometimes made into the upper part of the thorax 
(thoracotomy), a portion of a rib removed at a lower point, and the sac 
freely irrigated. Such operations are far less hopeful in our patients, 
in which treatment is generally a question, not so much of saving life, 
as of restoring usefulness. Under these circumstances the operation is 
burdened with conditions which it is unable to satisfy, and which render 
it difficult to carry out in private practice. The same is largely true of 
the surgery of the lung, lately introduced in man, which aims at direct 
operative treatment of diseased processes in the lungs and in other 
organs of the chest. As a last resort in the treatment of a valuable 
patient thoracotomy might, however, be tried. 
(8.) Tapping the Pericardium in the Hog. —In the dog, tapping 
the pericardium becomes necessary in the treatment of exudative peri¬ 
carditis, which occurs in the acute and chronic forms. Attention is 
always first attracted by the physical symptoms. 
As soon as the pericardium contains a certain quantity of liquid, 
the heart is thrust upwards and a little forwards, the degree of dis¬ 
placement depending on the amount of exudate. The pericardial sac 
becomes distended, especially about its base, lifting the pulmonary 
lobes, and pushing them upwards towards the vertebrae, though to a 
much less degree than in pleurisy. Thus on palpation of the pre¬ 
cordial region the heart’s impulse appears weak, or seems lost. On 
auscultation the normal sounds, clearly detected in health even in 
very small patients, are dull, distant, and smothered, or completely 
inaudible. When the heart is but slightly compressed the pulse pre¬ 
serves its character; but as soon as pressure becomes marked the pulse 
