Prognosis.—The prognosis depends on the cause and the circumstances under which the pneumothorax develops. It is favorable in apparently healthy indi viduals, the air being absorbed without the development of pleurisy. In trau matic cases the prognosis depends chiefly on the nature of the injury.
In tuberculous cases the prognosis is grave. The complication occurs usually in those in whom both lungs are af fected with the acute caseating types of the disease. Much depends on the con dition of the opposite lung; if it is only slightly diseased and the general condi tion good, recovery may take place, with absorption of the air and fair expansion of the lung. With extensive disease of both lungs a rapidly-fatal result is the rule. In thirty-nine cases collected by Sir R. Douglas Powell the average dura tion was twenty-seven days. In some cases, however, the condition becomes chronic and the patient is able to go about with a fair measure of comfort. Arrest of the tuberculous process some times follows the occurrence of pneumo thorax, but it does not necessarily follow.
One hundred and sixty cases of pneu mothorax collected, of which 104 died, giving a mortality of 62 V, per cent. The mortality in those cases in which the pneumothorax developed in the hospital was much higher (77 per cent.) than in those admitted some time after the condition has been established (33 per cent.). This is explained by the fact that the proportion of deaths is much greater during the first week than at any subsequent period. Death is due to either rapid suffocation or shock within a very short period after the rupture, or as a result of effusion, or as a result of the disease-process which produced the pneumothorax, usually phthisis. The prognosis depends upon (1) the urgency of the symptoms—that is to say, the amount of dyspncea and cyanosis; (2) the condition of the opposite lung, the development of roles being a very bad omen; (3) the ability of the right heart to overcome the increased resist ance in the pulmonary circulation, any sign of dilatation being unfavorable; (4) the general strength of the patient, par ticularly the development of the respira tory muscles; (5) the nature of the dis ease which has led to the pneumothorax.
Recovery from the disease is rare, but it may occur and may be apparently com plete and permanent. The most favor able cases are those in which there is no pulmonary disease and in which no effu sion has taken place. If the effusion does occur, but is purely serous in char acter, the prognosis is also good. S. West (Lancet, May S, '97).
From study of recurrent idiopathic pneumothorax without effusion follow ing conclusions are reached:— 1. That simple or idiopathic pneumo thorax is a very rare disease of the lungs and pleura.
2. That a repetition of the disease in the same lung is of still greater rarity.
3. That in a very small number of cases the entrance of air into the pleura —to stretch it to its utmost limits—does occur without any effusion of fluid; and this even may happen a second time in the same lung.
4. That the absence of fluid renders the disease less fatal than when air and fluid are effused.
5. That the presence of air in the pleura may occur without any febrile or constitutional disturbance.
G. That in the face of such possibilities we should be cautious as to giving too grave a prognosis when evidences of a ruptured lung and pleura are present, and particularly so when there is no previous disease.
7. That the tendency of such cases is toward spontaneous recovery, and, in the absence of urgent symptoms calling for relief, it is wiser not to employ surgical means to let off the effused air. J. M. Finny (Dublin Jour. of Med. Sci., Apr. 1, '9S).
Treatment.—In most cases this can only be palliative. If the onset is den, with severe symptoms, morphine should be given subcutaneously for the relief of the pain and dyspncea, and to soothe the mental distress. Stimulants are usually needed to counteract the tration. If the cyanosis and dyspncea be great, dry cupping may give some relief.
For the pain caused by the pleurisy that usually follows three or four leeches may be applied, followed by hot fomentations, after which the chest may be strapped.