128 
DEPARTMENT OF SURGERY. 
There are several sites selected for this operation : Moller 
recommends a point between the xyphoid cartilage and the 
costal cartilage [Fig. 44, b). Williams (W. L.) selects a point 
in the sixth intercostal space on the right side, and in the 
seventh on the left side [Fig. 44, b). (See Pfeiffer-Williams ’ 
Surgical Operations .) 
The most important thing to avoid in the procedure is the 
admission of air into the thorax [pneumothorax') ; this can be 
prevented by placing the finger over the end of the canula 
during inspiration, by using Billroth’s trocar, or by attaching a 
rubber tube to the end of the canula and immerse the distal 
end of the tube in a bucket containing water. 
Before inserting the trocar into the thorax the site of punc¬ 
ture must be scrubbed with soap and hot water, and washed with 
a strong solution of bichloride of mercury; the hair is then 
parted by the use of vaseline and the trocar inserted into the wall 
of the thorax at the part in the point selected, and the per¬ 
forator removed from the canula. If the flow is arrested by the 
accumulation of fibrinous material, cretified pus, or clots of any 
kind in the canula, the perforator must be introduced into it to 
remove such obstructions. Before removing the canula the 
perforator should be introduced into it to prevent drawing for¬ 
eign or septic material into the wound. 
Paracentesis, without some other treatment, is not a cure for 
hydrothorax, but a procedure that should not be used promis¬ 
cuously ; the removal of a large quantity of fluid has a debili¬ 
tating effect; therefore, the rational treatment of such cases is 
to encourage absorption, and only perform thorocentesis when 
the accumulation of fluid interferes with respiration. The 
treatment that we would recommend in addition to what has 
already been mentioned is the application of a good cantharides 
blister (i-i6)and the removal of fluids by puncturing only when 
necessary. 
2 . Pleurisy with Effusiojis. —We consider two forms of pleu¬ 
risy that terminate in hydrothorax ; the first form is sthenic, 
and the second is asthenic. The first may be considered the 
same as acute pleurisy, which, when neglected, terminates with 
effusion. It is characterized by high temperature, pain, dysp¬ 
noea, restlessness, short cough, ribs fixed, elbows turned out 
and forelegs are held apart. When the effusion begins to col¬ 
lect the temperature begins to lower gradually; pain becomes 
less intense ; restlessness is diminished, but dyspnoea continues. 
The second form is sometimes called “ quiet pleurisy.” It 
