PNEUMOTHORAX. 



287 



TREATMENT. Treatment of hydrothorax is identical with a treat- 

 ment of the main disease, and, as usually but little can be effected to 

 benefit the latter, our success is seldom good. When the dyspnoea is 

 very intense, and is manifestly dependent upon the profusion of the 

 transudation, its evacuation by tapping is indicated. The benefit tem- 

 porarily obtained in such circumstances is often very marked. 



JHAPTEK III. 



PNEUMOTHORAX. 



ETIOLOGY. We are not at liberty to suppose that under any cir- 

 cumstances gases are secreted by the surfaces of the pleura and collect 

 in its sac. It is manifest that the facts, upon which such a theory of 

 the origin of pneumothorax is based, have been falsely interpreted. I 

 will not absolutely deny that decomposition of a pleuritic effusion may 

 give rise to the development of gases in the pleura without the en- 

 trance to it of air ; but such occurrences are, at least, very rare. The 

 most common source of pneumothorax is the entrance of air into the 

 pleural cavity through an opening in the pulmonary surface, or through 

 perforation of the thoracic wall. 



Perforation of the pulmonary pleura may take place from within, 

 the destructive disease of the lung attacking the pleura ; or from with- 

 out, an injury or gradual degeneration of the tissues upon the surface 

 of the pleura penetrating the lung. It is by the first of these methods 

 that pneumothorax arises in pulmonary abscess, gangrene of the lung, 

 and consumption. Most of the cases of pneumothorax, which have 

 been reported, have occurred in phthisis (not in tuberculosis, as is com- 

 monly said), in consequence of the opening of a vomica into the pleural 

 sac. I would here remark that a tedious chronic consumption is far 

 less liable to result in pneumothorax tnan a consumption whose prog- 

 ress is rapid and subacute. When the disorganization of the lung pro- 

 ceeds slowly, the pleural surfaces usually become firmly adherent to 

 one another as the morbid process approaches the surface, so that, if 

 perforated, ah* cannot enter the cavity of the pleura. Quite often the 

 pneumonia, upon which the consumption depends, is of recent origin ; 

 no dulness, upon percussion, or bronchial breathing, at the apex of the 

 lungs, as yet being discoverable, the strength and nutritive condition 

 of the patient having suffered but slightly when the pneumothorax 

 forms. The rapid destruction of but a single lobule in a state of 

 caseous infiltration, and lying at the surface of the lung, might induce 

 the catastrophe. Besides the pneumothorax, arising from destructive 

 disease of the lung, there are other rare but well-autheni icated cases 



