DISEASES OF THE PLEURA Pleurisy with Effusion and Empyema.—New methods of tapping the pleura have been introduced, including the replace ment of the fluid by sterile air or oxygen by means of an apparatus like that for inducing pneumothorax. This may be particularly helpful in regard to chronic or recurrent effusions, more especially such as occur in association with malignant disease.
As regards empyema, the treatment of collections of pus in the pleura has changed considerably. The method employed varies with the cause of the empyema. In cases due to the pneumococcus, early drainage by means of removal of a small piece of rib is now the rule. In those due to streptococcal invasion repeated aspira tion is adopted, until the process is localized, or until the fluid withdrawn is actually pus instead of thin turbid fluid, after which drainage by removal of a piece of rib is employed. In both cases many surgeons now employ special appliances for drainage, where by a negative pressure is maintained in the pleural space to pro mote re-expansion of the lung. In empyema associated with tuber culosis, aspiration with gas replacement is the rule.
Surgery of the Pleura and Lungs.—war experience gave a valuable impetus to the surgical treatment of respiratory condi tions. The treatment of empyema has already been referred to. Haemothorax or blood effused into the pleural space is now treated like any other effusion, and aspirated or gas-replaced if necessary. If infected it is treated like empyema (q.v.). Artificial pneumo thorax is proving of great value as a preliminary to other operative procedures, apart from its uses as a means of treatment of pul monary tuberculosis. The operation of exairesis or avulsion of the distal part of the phrenic nerve as a means of treatment of chronic basic lung conditions, including pulmonary tuberculosis, is on its trial and bids fair to be useful. More extensive operative proce
dures are ligature of branches of the pulmonary artery, and lobectomy or removal of diseased portions of the lung.
Operations designed to promote collapse of the lung when this is impracticable by artificial pneumothorax are pneumolysis and thoracoplasty. In pneumolysis attempts are made to collapse the lung, by the insertion outside the pleura of fat tissue or some extraneous substance such as paraffin. In thoracoplasty, sufficient portions of as many ribs as may be necessary are removed to allow the chest wall to fall in and thereby collapse the lung. The out look in regard to the surgery of the lung and pleura is distinctly encouraging.
BIBLIOGRAPHY.-Sir R. D. Powell and Sir P. H. S. Hartley, Diseases of the Lungs and Pleura (6th ed. London, 1921, bibl.) ; F. W. Price (ed.), Textbook of the Practice of Medicine (1922) ; G. W. Norris and H. R. M. Landis, Diseases of the Chest (3rd ed. Philadelphia, 1924, bibl.) ; M. Fishberg Pulmonary Tuberculosis (3rd ed. London, 1922, bibl.) ; E. L. Opie and others, Epidemic Respiratory Disease (London, 1921, bibl.) ; Sir W. Osler and T. McCrae Modern Medicine (3rd ed., vol. iv., London, 1927, bibl.) ; S. E. Jelliffe Postencephalitic Respira tory Disorders (New York, 1927, bibl.) ; J. G. Townsend and E. Sydenstricker, Epidemiological Study of Minor Respiratory Diseases (Pub. Health Rep. 1927, xlii., 99) M. W. Hall, "Respiratory Group of Diseases as they Affect Soldiers and Sailors" (Mic. Surgeon, 1927, lx., I bibl.). (R. A. Y.)