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remained normal and the cough diminished in amount. Fourteen days after the extension of
the pulmonary collapse the physical signs had cleared up and an X-ray showed complete reexpansion
of the lung.
There is no doubt that, although undergoing treatment in the respirator, an
extension of the pulmonary collapse occurred in this case. The association in time
was sufficiently close to render the treatment suspect. If the respirator is held
responsible, the question arises as to whether it was unwise to institute treatment
during the acute pyrexial phase; or whether this type of case is unsuitable for
treatment along these lines. With our limited experience we can say that, in
empyema, where the collapse is due to external compression, the respirator acts
almost magically; with collapse due to some intrapulmonary cause, our experience
in one case has not been so happy.
Summary.
1. The use of the Drinker respirator in eight cases of diphtheritic diaphragmatic
paralysis is described. Such practical points as the type of case, the most
suitable time for commencing treatment, and the details of the working of the
apparatus are recorded. The conclusion is reached that the respirator is a necessary
adjunct to the treatment of this complication.
2. A new and promising use for the respirator is described. In three cases
of empyema in which the lung failed to re-expand after operation, a few short
treatments in the apparatus were sufficient to produce rapid re-expansion. A case
of collapse of the lung of intrapulmonary origin was not benefited by the respirator.
We desire to acknowledge our indebtedness to Dr. W. Gunn for placing his
American experience of the apparatus at our disposal; and to Dr. E. H. R. Harries,
medical superintendent of the North-Eastern hospital, for his valuable co-operation
and encouragement, and for his permission to publish these cases.
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