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OLEOTHORAX.
A survey of cases treated during the years 1930 to 1935.
By C. E. H. Anson, M.B., B.S., M.R.C.S., Senior Assistant Medical Officer,
Pinewood Sanatorium.
The use of oleothorax as an adjunct to artificial pneumothorax was first
advocated by Bernou in 1922, and good results have been reported by Gilbert and
others in selected cases. In recent years, however, this method of treatment has
fallen into disuse to a degree which in my experience is unjustified.
It would appear that the application of the treatment to unsuitable types of
cases, with resultant failure to secure clinical improvement, has contributed in no
small measure to the stigma under which oleothorax has fallen.
The following series of cases treated at Pinewood sanatorium between the years
1930 and 1934 therefore seems worthy of record, as it appears to us to demonstrate
clearly that in carefully selected cases treatment by oleothorax may be of great
and lasting benefit to the patient. Before proceeding to detailed summaries of these
cases, the indications for the treatment and the technique adopted may be considered
with advantage.
Indications
for
oleothorax.
The indications for oleothorax may be summarised thus:—
Partial oleothorax.—Indications : mediastinal laxity, combined with excessive
pleural elasticity in a case being treated by pneumothorax.
Complete oleothorax.—Indications : (1) obliterative pleurisy in pneumothorax,
or incomplete collapse of the lung, or an underlying cavity not due to adhesions;
(2) as a substitute for artificial pneumothorax.
Numerous authorities have also advocated oleothorax in the following
conditions : pleurisies complicating pneumothorax ; pleuro-pulmonary perforations.
Gilbert1 in 1930 divided the clinical types in which oleothorax was indicated
into two main classes, viz.:—(1) As a means of disinfection in chronic or relapsing
sero-fibrinous bacillary pleurisies, in severe tuberculous pleurisies, in certain
purulent effusions. (2) As a means of preventing adhesions in order not to lose the
good effects of artificial pneumothorax which until then had been effective.
The experience quoted here, while providing evidence of the value of oleothorax
in the second class of case, does not justify any conclusions on its use in cases
belonging to the first group or in cases with a pleuro-pulmonary perforation.
Good results have also been obtained with a partial oleothorax in cases showing
laxity of the mediastinum as mentioned above. There is little doubt, however, that
the recent progress made in the surgical treatment of pulmonary tuberculosis and
the complications of artificial pneumothorax by operative measures have removed
from the lists many cases in whom a few years ago oleothorax would have been
indicated and advised in the absence of any better form of treatment. In all cases
selected for this form of treatment, the contralateral lung should be free from any
appreciable degree of active disease.
Technique.
In all cases as complete an artificial pneumothorax as possible was secured
before the introduction of oil. In all cases liquid paraffin containing gomenol oil
in a concentration of from 2 to 5 per cent, was used. A preliminary injection of
5 c.c. was first given to test the susceptibility of the patient. If no intolerance was
observed further injections of 25, 50, 100 and then 300 to 500 c.c. were given, allowing
a few days to elapse between the injections, until the air in the pneumothorax space
had been completely replaced by oil. For the injections of the larger amounts
of oil a two-way Dieulafoy's syringe of 100 c.c. capacity, or the special
apparatus designed for the introduction of large quantities of oil by Dr.
W. C. Fowler was used. The oil was run in at body temperature, through a short
needle having a bore of from 1 to 1½ mm., inserted in one of the lower intercostal
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