Further particulars of a case of pneumato-thorax

Abstract

About a month after the operation described in Dr. Davy’s former paper, when the patient appeared to be doing well, symptoms of hydrothorax came on, and fluid again collected in the left side of the chest. A second operation therefore was performed, and fourteen ounces of fluid discharged through a perforation in the fifth rib. During the six following weeks not less than twenty pints of fluid ran off through the opening; at first it was transparent, but became gradually more and more purulent, and was mixed with air composed of oxygen, azote and carbonic acid, in various proportions. The patient’s health improved at first progressively, but in about six weeks after the operation he became worse, and expired suddenly. On examination after death, about six ounces of pus were found in the left pleura. The right pleura was healthy, but tubercles and vomicæ were found in the right lung; the left lung was much condensed, and communicated by two small openings with the pleura. Dr. Davy refers the origin of the disease in this case to a communication between the aspera arteria and cavity of the pleura, established by the rupture of a superficial bronchial tube, and the membrane covering it; and concludes the paper with some remarks upon the fluctuating composition of the air from the chest, which he attributes not to the varying quantity of atmospheric air, admitted through the perforation, which was as carefully closed as possible, but to its vitiation by respiration, and by the absorbent power of the pleura.