350 Pulmonic Interstitial Emphysema 



Atelectasis Neo7uitonim.—Ate\ectasis of the newborn is a special condition 

 which has recently come in for some intelligent investigation and operative 

 interference." ■'^ ^^ It is evident that airblock is quite prevalent in this class. 

 One might well speak of "PIE neonatorum." Certain progressive physicians 

 who have become aware of the common occurrence and serious nature of this 

 condition have examined, particularly by X ray, newborn infants who were 

 showing signs of respiratory distress, for the presence of air in the medias- 

 tinum. The lateral roentgenograms have been particularly useful in revealing 

 the signs of air in the precordial region, from whence it was withdrawn with 

 a hollow needle.' The dyspnea and cyanosis have in this way been strikingly 

 relieved, and children who have appeared moribund have recovered.' ' Not 

 only has the air in the mediastinum been thus withdrawn, but it would appear 

 from roentgenograms^ that air that has been in the connective tissues of the 

 lung, particularly in the vascular sheaths splinting it and holding it in a 

 position of inspiration, has to some extent been allowed to escape into the 

 mediastinum, whence it, also, could be withdrawn. This method of treatment 

 would seem best adapted for immediate and substantial relief of airblock, 

 draining off some of the air even from the interstitial tissues of the lungs, and 

 so relieving the disastrous effects of pressure on the intrapulmonary blood 

 vessels as well as on mediastinal structures. Doubtless also some air escapes in 

 time from pulmonic connective tissue apart from that of the vascular sheaths, 

 such as the interlobular septa. 



Autoresorption of Aberrant Air.— It has been averred by a nimiber of work- 

 ers*'^ that pneumomediastinum (and inferentially PIE) is a benign condition, 

 requiring no special treatment, as the air is resorbed in a few days or at most 

 weeks. This is doubtless true in some of the cases, but sometimes the patient 

 does not live long enough to resorb the air, but dies of asphyxia before his 

 unaided efforts can accomplish this desideratum. In the presence of such 

 tragedies it seems more than possible that many physicians have not realized 

 what was the real cause of death. Assistance in the form of prompt and ade- 

 quate withdrawal of the air from the anterior mediastinum may tide the 

 patient over an illness not necessarily in itself fatal in that patient at that par- 

 ticular time, but in the course of which he may succumb because, unaided by 

 surgical intervention, his circulation and respiration are too markedly im- 

 peded by the aberrant air. 



Why Aberrant Air Escapes Attention.— It might be asked at this point why 

 PIE and its sequelae have not been more often demonstrated in persons dying 

 of airblock. There are several reasons why it may have been overlooked, among 

 which may be mentioned the following: (i) autopsies, in proportion to the 

 total number dying, are not often done; (2) the autopsy is usually long de- 

 layed, so that a considerable amount of the air has diffused away after death; 

 (3) the air bubbles are obscured by blood and serum; (4) the operation of cut- 

 ting the lung bursts the bubbles and dissipates the air; (5) the pathologist was 

 not actually seeking air in the pulmonic vascular sheaths and other parts of 



