Pneumothorax : a historical, clinical and experimental study.

  • Emerson, Charles Phillips, 1872-1938.
Date:
1903
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Licence: Public Domain Mark

Credit: Pneumothorax : a historical, clinical and experimental study. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    trace of pleural adhesions, which the writer considers rare. A subpleural tubercle had ruptured. Case of Pyopneumothorax limited to the anterior part of the chest and pushing the heart to the right.—A tuberculous boy, 19 years old, developed partial pyopneumothorax on the left side, anteriorly and inferior. Death. Autopsy. 159. Powell (R. Douglas). Clinical Lectuees on Excavation of the Lung in Phthisis. Lancet, Feb. 2, 1S7S. In this lecture Powell deals with pneumothorax as an accident that may happen to a tuberculous patient. He reports that he found five cases in more than one hundred autopsies on phthisical patients. Clin- ically, he reports for seventeen cases. He speaks of the early phthisis with subpleural tubercles, in which it is most likely to occur, of the symptoms and of the physical signs, and of these especially, the displace- ment of the heart which he considers a sensitive index of the presence and degree of pleural effusions. He illustrates this by an artificial thorax with bladders as lungs, showing the effect of the elasticity of the lungs. So in the living subject at the moment of the occurrence of pneumo- thorax and before any pressure recognizable by a manometer occurs a notable and instantaneous displacement of the heart takes place. The clinical fact I want now to bring home to you from this demonstration is that displacement of the heart ... is not necessarily a sign of intra- thoracic pressure, and therefore, even when considerable, is not alone sufficient to call for relief by paracentesis. 160. Leichtenstern. Pneumothorax. Gerhardfs Handbuch der Kinder' krankheiten, Vol. 3, Part 2, page 962, 1878. Etiology.—1. Inflammatory processes of the lung leading to ulceration of the pleura. This includes the most various chronic pulmonary diseases leading to cavity formation, etc. . . . the purulent or caseous lobular pneumonia in children, the result of the catarrhal pneumonia which so often follows measles; purulent or gangrenous pulmonary emboli; metas- tatic or other forms of lung abscess, lung gangrene. 2. Empyema rupturing through the lungs. (Page 896. In very many of these cases during the whole process of healing it does not result in demonstrable collection of gas in the pleural cavity, never in pyopneumo- thorax.) 3. Trauma, including those very rare cases occurring in whooping- cough. Penetrating wounds, etc. Anatomical Findings.—He believes the pleura is filled in valvular cases by inspiration. Symptoms.—Two cases are report?d, one of sudden death at onset, one of latent pneumothorax. He emphasizes again the value of his Plessi- meter Stabchen percussion (the auscultation of the percussion on the plessimeter). Under Therapy he advises the puncture of the thorax with a capillary trochar repeated as often as necessary.