Air and blood intermingle in the pleural cavity from the lung and from the parietal wound. If the latter is small or tortuous, the air from the pleural cavity may infiltrate along the fascial planes about the wound (see Section III), while, if the external wound is large, instead of this subcutaneous em physema there is "traumatopncea": a rush of air in and out of the wound each time the patient breathes.
The subsequent course of a wound of the lung is quite that of a ruptured lung; but added to the danger of hmm orrhage and sepsis from within is the danger of haemorrhage and sepsis from without.
In hmmothorax from penetrating wounds of the chest, the diagnosis lies between an injury to a large or a small vessel and the integrity of the thoracic organs. When the respiration cannot be heard behind and laterally at a line pass ing through the scapula, and when this is accompanied by a t•mpanitic note above, when there is a pulse of from 110 to 120 and a cold sweat, a large vessel has been injured and a bronchus of some size has been invaded. When, on the other hand, the respirations are not in creased above 25 or 30 to the minute, and the flatness is limited to the base of the lung posteriorly, the pulse being be low 105, the hmmothorax is limited and a small vessel has probably been cut. Barto (Gaz. Ilebdom. de 1116d. et de Chin, Apr. 29, 1900).
— The treatment of a laceration of the lung and its quences are considered elsewhere (see liuntmE OF THE LUNG).
'The added dangers, sepsis and lnemor rhage from the parietcs, require local therapeusis. On seeing the patient the
surgeon's first efforts are directed to in suring his rest and stimulation, and at the same time he treats the wound in the thoracic wall as an ordinary surgical wound, endeavoring to obtain asepsis by the removal of foreign bodies and copi ous irrigations with sterile solutions, and haemostasis by pressure or ligature.
As regards asepsis, it must be remem bered that under ordinary circumstances all endeavors to attain it shall stop short at the parietal wound and respect the pleural cavity, for irrigation of the latter is calculated to do more harm by increas ing the shock and renewing or encourag ing the internal bleeding than it can pos sibly do good. For the same reason the solutions used to wash the wound should be simply aseptic, and not antiseptic, so that the portion of them which is lost within the thorax may not be irritating.
As to hmmorrhage, patients have died of bleeding from a wounded intercostal or internal mammary artery. Hence the surgeon should not be satisfied until he is absolutely certain that all parietal haemorrhage is checked.
Whether or not the wound shall be sutured at once is not always easy to decide, but the rule is to suture if pos sible, and to exercise especial care in obtaining apposition of the deeper structures so as to prevent any extensive emphysema about the wound.
The treatment of hernia of the lung, etc., is referred to in another section.