PNEUMOTHORAX. AIR OR GAS IN THE PLEURA. 



Causes, decomposition of liquid effusion, perforation from a bronchium, 

 the stomach, a thoracic wound. Symptoms, metallic tinkling, splashing, 

 succussion, drum-like resonance, suppressed respiratory murmur, distance 

 of cough sound, distress, anxiety, dyspnoea, bulging intercostal spaces, 

 sometimes a wound. Treatment, closure of wound, calmatives, aspiration 

 of gas. Treatment for pleurisy. 



The collection of air or gas in the cavity of the pleura has al- 

 ready been noticed as co-existing with liquid effusion in some 

 cases of advanced pleurisy. It may arise from other causes, 

 among which may be noted : i. When a mass of pulmonary 

 tubercle connected with a bronchial tube has opened into the 

 pleural sac. 2. When a communication has been established be- 

 tween the pleural cavity and the alimentary canal, as in combined 

 rupture of the stomach and diaphragm, or of the double colon and 

 diaphragm. 3. When a rib is fractured and the broken end pen- 

 etrates the lung tissue and opens into one or more small bronchial 

 tubes. 4. When a wound has been inflicted penetrating the walls 

 of the chest and forming a valvular orifice through which air is 

 drawn inward during each inspiratory act, but out of which it 

 cannot pass when the thorax collapses. 



The amount of gas present may be extremely slight, or in a 

 case such as that from a valvular wound it may cause complete 

 collapse of the lung, falling up the entire half of the thorax and 

 bulging into the opposite half. 



The symptoms are often very obscure. If with liquid the me- 

 tallic tinkling after rising, in small animals the splashing when 

 shaken and the other sounds of auscultation and percussion will 

 point it out as described under pleurisy. In the case of a broken 

 rib the distortion, swelling and tenderness, will lead to suspicion. 

 A penetrating sound will be sufficiently evident, and in the case 

 of tubercle previous cough and ill-health will have been manifest. 



The specific signs of uncomplicated pneumothorax are : ist, A 

 drum-like resonance on percussion over the seat of the gas, 

 usually at the upper part of the chest ; 2d, A partially suppressed 

 or distant respiratory murmur over the same area ; 3d, A muffled 

 or suppressed sound of thecough ; 4th, Sometimes, especially if the 



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