Hernia of the Lung

HERNIA OF THE LUNG. - Hernia of the lung (pneumocele) occurs either through a wound in the thorax or in a yielding scar.

When it occurs in a wound, the lacer ation of the thorax is usually extensive and the lung unharmed. In the flutter ing, irregular motions of the lung, its edge is protruded through the wound and then caught. Unless it slips back or is replaced it soon becomes oedematous and subsequently hardened, perhaps gangrenous.

The subcutaneous form of hernia is apparently always reducible.

— When the hernia is through a wound its reduction must first be attempted. If this fail, or if the lung become gangrenous, it must be cut away with the thermocautery or allowed to slough away.

The other variety may be reduced and held in place by a pad or a broad belt.

IV. Foreign Bodies in the Chest.— Foreign bodies in the heart and peri cardium have already received mention.

The foreign bodies in the chest pro duce no very characteristic symptoms. Their presence is usually suspected from the history, a history of inhaling some object (see TRACHEA, FOREIGN BODIES IN), ulceration from the wsophagus, or a wound of the chest. The last class

alone concerns us. These foreign bodies —bullets, fragments of bone, splinters of wood, shreds of clothing — are often either unsuspected or inaccessible. If they can be removed from the wound without probing they had best be ex tracted at once. If left in situ, whether in the chest-wall, the mediastinum, the lung, or the pleura, they may, if clean, become capsulated and never be heard from, though more frequently they be come infected and set up suppurative or gangrenous inflammation, such as em pyema or abscess, or gangrene of the lung. When such complications occur after a wound of the chest, the possi bility that they are caused by a foreign body may often only be excluded by the use of the x-rays. The treatment is ex traction of the object by thoracotomy or pneumotomy, and subsequent drainage.

V. Secondary Complications.