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spaces. While the oil was being introduced, the air in the pneumothorax space
was slowly removed through another needle, inserted in the first or second intercostal
space, by a reversal of the bottles of the pneumothorax apparatus. The intrapleural
pressure at the end of each injection was adjusted to zero. In some cases
where difficulty is experienced in removing the last traces of air when completing
the oleothorax, the patient may be placed on the side with the buttocks raised, and
the head and shoulders low, and the needle coupled to the pneumothorax apparatus
inserted in the costo-phrenic angle. By this means the last traces of air can be
completely removed. In cases being treated by partial oleothorax from 40 to 100 c.c.
of oil only are required. In my experience the after-care of all cases treated by a
complete oleothorax is of the first importance, and wherever possible the medical
officer responsible for the induction of the oleothorax should personally undertake
the after-care and refills, if the best results are to be obtained. Careful routine
X-ray and clinical examinations, including blood sedimentation tests, and periodic
observations of the intra-pleural pressure, and the giving of small refills should this
begin to fall, are essential. Should fluid develop under the oil, it should, if serous,
be removed and replaced by gomenol-paraffin. Should it persistently reform, or
be found to be purulent, on more than one occasion after replacement, the oleothorax
should be terminated
The following eight cases, treated by complete oleothorax, serve to illustrate
some of the foregoing remarks. Throughout the series the blood sedimentation
readings refer to the fall at the end of two hours.
Cases
treated.
Case 1.—Aged 20 years. Admitted 25.6.29.
History.—Previously treated at another sanatorium, 1928. Relapsed with cough and loss
of weight in June, 1929.
On admission.—Impaired percussion note with prolonged expiration and post-tussive
crepitations over the upper half of the right lung. Sputum positive. Blood sedimentation 50.
X-ray.—15.7.29. Infiltration over the upper half of the right lung, with small apical
cavity. Left lung clear.
Treatment.—Right A.P. induced 23.7.29, full collapse prevented by adhesions. Adhesions
divided 6.5.30. Improved collapse, but base adherent. To prevent the obliterative process,
oleothorax, using 5 per cent, gomenol in paraffin, was induced on 20.7.30. By 7.8.30 in all
500 c.c. of oil had been given, when patient developed a severe reaction with hyper-pyrexia and
pain, and signs of acute nephritis, with blood and casts in the urine. The oleothorax was at once
abandoned, and all the oil removed from the right chest, which later filled with clear fluid, which
slowly organised. The urine cleared, and patient was discharged on 20.6.31 much improved,
with sputum negative, blood sedimentation 20, and signs only of pleural thickening over the
right side.
Subsequent history.—In-patient for two months at Royal Free hospital with recurrence of
urinary symptoms in November, 1931. Diagnosed as renal tuberculosis. Last seen 4.1.35, free
from urinary and pulmonary symptoms, clinical signs and X-ray diffuse pleural thickening over
right side.
Case 2.—Aged 29 years. Admitted 15.11.29.
History.—Left-sided pleurisy and small haemoptysis six weeks prior to admission.
On admission.—Impaired note and some moist sounds over the upper third of the right
lung. Sputum positive. Blood sedimentation 26.
X-ray.—4.2.30. Deposits over the upper half of the right lung. Left lung clear.
Treatment.—Right A.P. induced 10.2.30. Complete collapse prevented by adhesions.
These were divided on 6.10.30. A small basal effusion developing, oleothorax was induced on
11.10.30 to prevent an obliteration of the A.P. as a result of adhesions forming at the base after
the absorption and organisation of the basal effusion. Discharged 17.4.31 with a complete
oleothorax, no symptoms, sputum nil, blood sedimentation 34.
Subsequent history.—While attending dispensary she developed fluid under the oil. It was
at first serous, but not being treated or replaced by oil it became purulent. Re-admitted to
I'inewood 29.4.32. Right chest drained and pleural wash-outs given. Gelatinothorax started
12.8.32, completed 23.8.32. Discharged much improved 23.2.33.
Re-admitted with recurrence of pus in the right chest on 22.8.33. Transferred to Brompton
hospital for thoracoplasty after a course of pleural wash-outs to promote pulmonary re-expansion
on 11.5.34. Thoracoplasty 1st stage 25.5.34, 2nd stage 8.6.34. Returned for convalescence and
was finally discharged in moderate health on 1.2.35.
Case 3.-—Aged 21 years. Admitted 27.6.30.
History.—Recent haemoptysis.
On admission.—Impaired note with some moist rales and prolonged expiration over the
upper third of the right lung. Sputum positive. Blood sedimentation 12.