Pneumothorax

PNEUMOTHORAX. The lungs are elastic organs kept extended by their indirect attachment to the walls of the bony thorax. This is effected through the intervention of the pleura (see COELOM and SEROUS MEMBRANES), the surfaces of which are held in contact by atmospheric pressure, and glide over one another during respiration. If gas or air gain entry to the pleural cavity, the lung on account of its elasticity tends to collapse and empty itself of air. This is the condition known as Pneumothorax, and according to the means of its production is spoken of as Spontaneous or Artificial.

Spontaneous Pneumothorax.

This is generally due to the rupture of an air-containing lung into the pleural sac, commonly caused by softening of a tuberculous nodule. According to the size and nature of the rupture the pneumothorax is formed gradually, with slow development of symptoms, or suddenly with immediate and urgent distress. A rapid and complete collapse of one lung, accompanied, as commonly happens, by encroachment of the chest contents on the other lung, leads to severe breath lessness. Where, however, the collapsed organ was extensively diseased its loss may be less urgently felt and occasionally its collapse may be actually beneficial. It was largely the benefit arising from certain of these cases that directed attention to the idea of inducing collapse artificially. In most cases of spontaneous pneumothorax the pleura becomes inflamed, and fluid, whether thin or purulent, transforms the condition into a hydro- or pyo pneumothorax.

Artificial Pneumothorax.

Otherwise known as pneumo thorax treatment, or as collapse-therapy, artificial pneumothorax was first urged on theoretical grounds in 1821 by an Irishman, James Carson of Liverpool. His views were supported by clini cal observations on Spontaneous Pneumothorax (Houghton, 1832; Stokes, 1837), but not till so years later did Potain (1884) put air into a spontaneous pneumothorax, and Cayley (1885) treat a case of haemoptysis by this method. The treatment on its modern lines may be said to originate with Forlanini, who reported his first cases in 1894-5.

The aim of this treatment is the collapse of a diseased lung, where disease does not respond to other measures, and the other lung is sufficiently sound. Its main field has been pulmonary

tuberculosis, but it has also been used in lung abscess and bronchiectasis, in the diagnosis of obscure lung conditions, especially tumours, and to assist the surgeon in certain chest operations. The gases used are commonly air, nitrogen or oxy gen, according to the requirements of the case.

The gas is delivered from a "gas bottle" connected with a "pressure bottle" containing fluid, and enters the chest through a special needle attached to a water manometer to control the pressure. It is introduced in small quantities at first and collapse brought about slowly. As it collapses the lung squeezes out the diseased secretions it contains, and these are brought up as sputum. In a favourable case the sputum then ceases, the temperature be comes normal and the patient regains his lost health. Gas is intro duced every few weeks, and treatment is carried on till disease is judged to be healed. The lung is then allowed to expand and does so to a varying extent. The main impediment to pneumo thorax treatment is the occurrence, in a large proportion of cases, of adhesions between the surfaces of the pleura. The main source of failure during its course is the development of fresh disease in the functioning lung. The success of pneumothorax treatment in severe tuberculous disease has been very notable, at least so% being improved, arrested or cured.

BIBLIOGRAPHY.--Medical Research Council,

Special Report No. 67, Report on Artificial Pneumothorax (H.M. Stat. Off., 1922) ; C. Riviere, The Pneumothorax and Surgical Treatment of Pulmonary Tuberculosis (2nd ed. London, 1927) ; J. B. Amberson, Jr. and A. Peters, Pulmonary Tuberculosis; its Treatment by Induced Pneumo thorax in H. Lilienthal's Thoracic Surgery, vol. ii. p. 320 (Philadelphia, 1925, bibl.) ; J. Gravesen, Surgical Treatment of Pulmonary and Pleural Tuberculosis (London, 1925) ; J. Alexander, Surgery of Pul monary Tuberculosis (London, 1925, bibl.). See also E. Loewenstein, Handbuch der Gesamten Tuberculose-Therapie (Berlin, 1923).