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X-ray.—14.7.30. Deposits over the upper half of the right lung.
Treatment.—Right A.P. induced 12.8.30. Complete collapse prevented by apical adhesions.
Cauterisation of adhesions at Brompton hospital 24.11.30 to 20.2.31. On her re-admission it
was found that as a result of a small haemothorax which developed after her cauterisation there
was danger of her pneumothorax obliterating. Oleothorax was started 5.3.31 and completed
19.4.31. She was discharged on 4.9.31 free of symptoms, with a complete oleothorax—sputum
nil, blood sedimentation 10.
Subsequent history.-—Has remained free of symptoms since discharge. In business for past
3 J years. Last seen 25.1.35. Complete oleothorax, no symptoms.
Case 4.—Aged 30 years. Admitted 17.4.31.
History.—Haemoptysis at intervals for past five years.
On admission.—Impaired percussion note with post-tussive crepitations over the upper
half of the left lung, and also over the right apex. Sputum positive. Blood sedimentation 21.
X-ray.—24.7.31. Diffuse deposits with softening over the upper half of the left lung, with
a few scattered deposits in the right middle zone also.
Treatment.—Left A.P. induced 12.8.31. Course of sanocrysin (5.9 grammes) completed
8.12.31. A small effusion developed in the A.P. space on 12.10.31, and was replaced on several
occasions. It had practically disappeared by February, 1932, but to prevent obliteration of the
A.P. as the result of this effusion, oleothorax was started on 24.2.32, and completed 8.3.32.
Discharged with no symptoms and a complete oleothorax on 26.4.32. Sputum nil. Blood
sedimentation 8.
Subsequent history.—Uninterrupted progress since discharge. Last seen 7.12.34, no
pulmonary symptoms, complete oleothorax ; has been at business for past year.
Case 5.-—Aged 21 years. Admitted 30.6.31.
History.—Persistent cough since influenza in November, 1930.
On admission.-—Impaired percussion note with post-tussive crepitations over the upper half
of the right lung. Sputum positive. Blood sedimentation 32.
X-ray.—13.8.31. Diffuse deposits over the upper half of the right lung.
Treatment.-—Right A.P. induced 21.9.31, good collapse resulted. Effusion (serous)
developed 29.11.31, gas-replaced 23.1.32. Very little re-accumulation occurred, but owing to
risk of obliterative processes oleothorax was started on 3.4.32, and completed 26.4.32. Discharged
31.5.32 free of symptoms, complete oleothorax, no fluid, sputum nil, blood sedimentation 17.
Subsequent history.-—Married against medical advice soon after discharge. Seen every
three months, and kept well till 25.8.33. Then failed to attend till 15.5.34, was confined during
the interval, and while feeding the child developed severe breast abscesses. When seen on
15.5.34 she was free of pulmonary symptoms; oleothorax complete. Between 4.9.34 and her
last visit in January, 1935, she had had a second pregnancy terminated on medical grounds, but
was still free from any pulmonary symptoms, and the lungs had stood the excessive strain of the
two pregnancies in such a short interval of time excellently, although her general health was
impaired to some extent.
Case 6.-—Aged 25 years. Admitted 1.1.32.
History.—Small haemoptysis December, 1931.
On admission.—Impaired percussion note with bronchial breath sounds, increased vocal
resonance and post-tussive crepitations over the upper half of the right lung. Sputum positive.
Blood sedimentation 28. Larynx : infiltration of both cords with interarytenoid deposits.
X-ray.—14.1.32. Infiltration and fibrosis over the upper two thirds of the right lung, with
large cavity in the middle zone. Left lung clear.
Treatment.—Right A.P. induced 18.1.32. Complete collapse prevented by apical and
basal adhesions. Adhesions at apex cauterised 18.4.32. A small fluid effusion followed,
subsequently partly organised, while thoracoscopy on 23.4.32 showed that the division of further
basal adhesions was impracticable. Oleothorax was therefore started on 1.8.32, to prevent the
march of the obliterative process at the base of the pneumothorax, and was completed on 3.9.32.
Discharged free from symptoms with a complete oleothorax on 12.9.32. Sputum negative.
Blood sedimentation 28. Larynx healed.
Subsequent history.-—Remained well since discharge. Last seen 22.8.34. No symptoms.
Complete oleothorax, blood sedimentation 4. Plays a round of golf with comfort and no latigue.
Case 7.—Aged 17 years. Admitted 1.3.32.
History.—Left-sided pneumonia 1931, left A.P. induced at St. Thomas's hospital August,
1931. Transferred to Pinewood, March, 1932.
On admission.—Clinical signs of a left-sided artificial pneumothorax. Heart displaced
slightly to right. Impaired percussion note and fine crepitations over right apex. Sputum nil
(positive before A.P.). Blood sedimentation 17.
X-ray.—10.3.32. Good A.P. (left), some deposits over the upper half of the right lung
with apical softening.
Treatment.-—Sanocrysin (5-9 grammes) completed 21.6.32. Developed fluid in A.P. space
30.5.32. Gas-replaced on several occasions, and small amounts of gomenol-paraffin introduced
100 c.c. in all being given. Fluid became purulent, and persisted in that state despite the
presence of the oil. On 16.9.32 oleothorax was therefore abandoned, and a gelatinothorax
started on 1.11.32. Small sinus discharging thin pus developed over the 7th space posteriorly