THE NEED FOR RESEARCH IN ANTE-NATAL PATHOLOGY
Authors: A. Routh
Journal: BMJ (1914)

lung for radiographic purposes, but I believe it is the only efficient means we possess for the treatment of chronic cases of tuberculous pyopneumothorax.As the radiograms show, it is possible in these cases, by replacing the gas and fluid by oxygen, gradually to draw out the lung without producing any symptoms of distress or discomfort.The process must be repeated on three, four, or even five occasions at intervals of two or three weeks, leaving on eachl occasion an increasingly hligh negative pressure.If the lung is completely fixed by adhesions, it cannot be made to re-expand, but it will be found that the tendency for the fluid (at first pus, and then serum) to reacoumulate will rapidly diminislh-a state of affairs which is greatly appreciated by the sufferer.One of my patients with a pyopneumothorax, who had been unable to work for five months owing to the discomfort and shortness of breatb, occasioned apparently by the pus (which was sterile), has been at work for over a year since I treated him by this method.Although lhe lhas only one lung, he says he is inconvenienced by shortness of breatlh only when he has to climb a long ladder.Two cases I would like to recount in greater detail.-CASE I.A man, aged 24, developed, in January, 1913, acute pneumo- thorax, and was a(Imitted to University College Hospital, under Sir John Rose Bradford, with a hydropneuimothorax.The lung wt's collapsed against the mediastinum and the fluid reached the level of the angle of the scapula.At the beginning and at the end of June I withdrew the fluid by oxygen replacement, withdrawing on the first occasioin 3,060 c.cm. and on the second 1,260 c.cm.When I saw the patient again in August there was some fluid but no gas in his chest.The upper part of the lung was expanding.I withdrew on this occasion by oxvgen replacement 1,860 c.cm. of fluid, and an x ray taken imme- dliately after showed that practically all the fluid had been removed, and that the lung had expanded, still further.The patient retuirned to full work in October, and I was unable to see liim until three weeks ago.The skiagram Inow shows com- plete expansion of the greater part of the lung, marked tlhickening of the pleura, and possibly a little fluid at the L-ase. CASE II.A man, aged 39, seven years ago had an attack of pneumonia onl the right side.After the attack had subsided, he was " tapped," according to his account, and pus was withdrawn from the right pleural cavity.He was again "tapped " on four subsequent occasions during the next two years, pus being obtained each time.When admitted to University College Hospital under the care of Dr. Boltoil in August of last year, the right side of his chest was full of fluid.He was wasted, and suffered from breathlessness and genieral debility, but there was no cyanosis or clubbing of the fingers.He was aspirated on August 30th aind 2,280 c.cm. of fluid drawn off.This fluid was thick and yellow, in appearance resembling pus.It was found to consist of masses of epithelial cells, pus cells, and lympho- cytes, anid contaiined two lipoidls.It was, however, sterile.'rlie following day this radiogram was taken (Fig. 2).On September 1st I removed by oxygen replacement 2,800 c.cm. of a fluid similar in character.The variations in pressure