Air in the Chest. Pneumothorax.
THIS disease consists in the presence of air in the cavity of the pleura. Generally, there is also water in the pleural sac at the same time; the water, being the heavier fluid, occupying the lower part of the cavity, and the air the upper part.
Physical Signs. Tympanitic or drum like sound over the upper part of the side. Dull sound over the lower part. Breathing murmur diminished or suppressed. Amphoric breathing. Metallic tinkling.
General Symptoms. Great oppression of the chest, and difficulty of breathing; generally attended by palpitation of the heart, and frequently by severe pain under the breastbone, on the affected side. The patient generally has to remain in the sitting posture, and ca a. not lie an instant on the sound side.
If, on percussion, one side of the chest sounds louder than the other and the breathing murmur is heard distinctly on the side which gives only a moderate sound, and is not heard at all on the loud sounding side, we may be sure it is a case of air in the chest.
Observations. The metallic tinkling is like the sound produced by dropping a pin's head into a metallic dish, or like the distant tinkling of a sheep bell, or the gentle pulling of the string of a violin.
It is supposed that when the fluid in the cavity of the pleura happens to be higher than the orifice, the air, when it enters at each indrawn breath, forces its way up through the fluid, in the shape of bubbles, and bursting at the surface, gives the tinkling sound. This sound is sometimes produced, too, by the falling of drops of liquid from the upper part of the cavity, upon the surface of the fluid.
The amphoric breathing is like the sound produced by blowing obliquely into an empty cask. One writer says he beard the same sound when out shooting on a rough day, produced by the wind blowing sideways into the gun barrel.
Treatment. I would recommend the use, two or three times a day, of the antiseptic inhalant, mentioned under the head of consumption.
Sweating must be encouraged in the manner recommended under acute bronchitis.
For the difficulty of breathing, give half grain doses of cannabis indica, or five drop doses Of tincture of aconite, or one sixth of a grain doses of svapnia. Extract of belladonna, or of stramonium, is also worthy of trial.
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