PNEUMOTHORAX.
In the majority of cases of this condition there should be little done to interfere with the natural process of resolution, as the opening in the pulmonary pleura tends spontaneously to close and the air to be absorbed.
When pneumothorax occurs in apparently healthy individuals, usually after some severe muscular effort, the shock may be so great as to require free stimulation by a dose of Alcohol or Sal Volatile; pain and distress likewise may call for a full hypodermic of Morphia, and should any distension of the right heart occur and the ventricular action become feeble, Strychnine hypodermically may be clearly indicated. With a full hounding action of the ventricle accompanied by much dyspncea the usual advice to apply leeches should be discarded and a vein should be promptly opened.
Dyspncea and cyanosis or asphyxia are, however, most frequently the result of mechanical pressure of the distended pleural sac (with air under increased pressure) causing great displacement of the heart. The best procedure in this condition is to thrust between the ribs a fine trochar and canula, or the hollow needle of the aspirator, and permit the escape of the imprisoned air, but aspiration should not be employed. After air ceases to escape spontaneously the affected side may be firmly strapped, but resort to this procedure without previous tapping can only aggravate the patient's distress, and sometimes, even after tapping, the pressure of the air still escaping through a valvular rent in the pleura will necessitate the removal of the plaster or bandage.
When the mildness of the symptoms permit, undoubtedly the best line of treatment is to place the patient at absolute rest in bed, and refrain from tapping in order to encourage or hasten the sealing up of the puncture in the pulmonary pleura, after which the air will become slowly absorbed and the collapsed lung expand again.
Some fluid nearly always accumulates in the pleura, and for the reason just stated this had also better he left alone for a considerable time; after the spontaneous closure of the pleural wound it may, like the air, become absorbed, but if after the expiration of a few weeks the fluid remain and there is displacement of organs, aspiration should be performed. Frequent aspiration is to be avoided; when a considerable quantity of fluid continues to reaccumulate it is best to freely incise the thorax and provide for the drainage as in empyema, and this should he done at once when the fluid is purulent.
In traumatic cases where the wound in the pleura can be located Macewen advises the resection of a rib and pressure over the abdomen and chest to bring the two layers of the pleura in contact, when they will then be held in position by capillary attraction as soon as the lung expands.
Pneumothorax occurring during the late stages of phthisis is very liable to be immediately followed by purulent accumulation. and when the Condition of the patient permits the cavity should be opened and drained.