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on 31.1.33. Frequent pleural wash-outs with 1 in 4,000 acriflavine in saline were given, and the
gelatinothorax abandoned. Discharged 16.6.33 with slight discharge from the sinus, general
condition poor, blood sedimentation 11.
Subsequent history.—Unknown, but unimportant from the point of view of oleothorax.
Case 8.—Aged 26 years. Admitted 18.10.32.
History.—Haemoptysis six years previously Treated at two other sanatoria from
February, 1929, to February, 1931. Right A.P. started during this time. "Influenza" in
December, 1931. A.P. abandoned early 1932 "as she had had it for three years." Relapsed
with recurrence of positive sputum in August, 1932.
On admission.—Impaired note with crepitations and bronchial breath sounds over the
upper, middle and lower zones of the right lung. Sputum positive. Blood sedimentation 19.
X-ray.—25.10.32. Fibrosis and deposits over all zones of the right lung, with apical
softening and cavitation.
Treatment.—Right A.P. re-induced on 10.1.33, after a small haemoptysis (2 ounces).
Moderate collapse resulted with great clinical improvement. The apex and base of the lung were
adherent to the chest wall, and as complete obliteration at any early date seemed probable an
oleothorax was started on 24.2.33, and completed on 3.4.33. Discharged to Papworth village
settlement on 22.5.33, free of symptoms, complete oleothorax, sputum nil, blood sedimentation 23.
Subsequent history.—Not known. Case not seen since transfer.
In the above series of cases, with the exception of cases 1, 2, 7 and 8, the
patients have been kept under personal observation at three to four months intervals
from the time of their discharge from the sanatorium to the date of the last report
quoted. During this time they have also attended their dispensaries for observation,
but subsequent refills, where necessary, or observations on the intra-pleural
pressure in the oleothorax, have all been carried out personally.
Discussion.
Analysing these results it is apparent that of seven cases treated by oleothorax,
with a view to preventing premature obliteration of the pneumothorax which had
given great clinical improvement, one case had to be abandoned owing to severe
local reaction and nephritis before the oleothorax was completed; one case
developed fluid, which later became purulent while out of our care, which necessitated
abandoning the oleothorax ; while the remaining five cases were greatly improved
and have remained well without relapse for periods up to three and a half years
after their discharge from the sanatorium. In four of these cases, the patients have
been engaged for a year or more in normal life or business posts.
It is of interest to note that in case 1 of the series 5 per cent, gomenol was used,
while in all the rest, except case 7, 2| per cent, gomenol was used. In the former
the acute nephritis was attributed to the strength of the gomenol, causing inflammation
of the renal tubules during its excretion, as no evidence of tuberculosis
affecting the urinary tract was found during the patient's stay in the sanatorium.
Case 2 serves to emphasise the importance of personal observation of all cases
treated by oleothorax, if complete.
In the only case (case 7) in which oleothorax was used as a treatment for a
persistent effusion in a pneumothorax space, the result was a complete failure.
With the exception of case 1, no complications attributable to the oil were met
with in this series of cases.
The cases treated at Pine wood sanatorium for the years 1930 to 1935 by
complete oleothorax are reviewed, and the indications for oleothorax, and the
results in this series of cases are recorded.
Summary.
I am indebted to Dr. W. C. Fowler for permission to publish these cases.
Reference.
1 Gilbert, M., Tubercle, 1930, 11, 385.