Pneumothorax and Posture. 



7 



moment, however, that the stitch was cut and the heart allowed to 

 drop backward, the typical pneumothorax symptoms appeared. In 

 a second dog, lying on his belly, the pericardium was attached to 

 the posterior chest wall by a stitch before the pleura was widely 

 opened. The heart could therefore not drop toward the anterior 

 chest wall. When an opening was made in the pleura of this 

 animal, the typical pneumothorax symptoms started. They ceased 

 soon after the stitch was cut and the heart allowed to drop 

 toward the sternum. In this way it was often possible to reverse 

 conditions ; to put a dog with an open pneumothorax on its belly 

 into the condition of one on its back, and vice versa. 



From the above experiments, the conclusion may be drawn 

 that in dogs, at least, pneumothorax is better borne when the 

 animal is on its belly than when in any other posture. The reason 

 therefore is to be found in the change in the position of the heart 

 in the thorax when the animal is on its belly. 



I may be permitted to add that I have in Mt. Sinai Hospital 

 and in private practice operated upon a number of patients with 

 empyema, upon a patient with a bronchiectatic cavity, on one with 

 a subphrenic and one with a liver abscess and had the patients 

 lying flat on the abdomen during the operation. In all of the 

 patients the pleura had to be opened. The last three patients in 

 whom an almost normal pleura was opened showed unusually few 

 untoward symptoms when the opening was made and air entered 

 the pleural cavity. In the patients in whom an operation for em- 

 pyema was done, it was noted that with only one exception the 

 coughing and interference with breathing that is regularly observed 

 when the opening in the pleura is made for this affection, was 

 entirely absent. Of course I am aware that these cases are too 

 few to be conclusive. 



At the French Surgical Congress of this year, Depage advised 

 that all operations on the chest should be done with the patient 

 lying on his abdomen ; Kocher, in the last edition of his Operative 

 Surgery, which has just appeared, states that in operating on the 

 lung the patient should be on his back, and he adds in parenthesis 

 "possibly also on the abdomen." 



The writer desires to thank Dr. S. J. Meltzer, in whose depart- 

 ment the work was done, for much aid and many suggestions. 



