Pneumothorax apparatus

by Alethea Drexler, archives assistant
mcgovern@exch.library.tmc.edu
We got a visitor on Monday who brought us a new gadget.
Meet the pneumothorax apparatus:

 

(double-click on image for a larger version)

This machine, which is a little over a foot tall and has a cylinder about six inches in diameter, was used to induce artificial pneumothoraces in tuberculosis patients.  A pneumothorax[1] is when air or gas fills up the pleural cavity, the space inside the chest cavity but outside of the lungs.  We used to see this at the veterinarian’s office when an animal had a punctured lung (it was not unusual in hit-by-car cases) but it is a common artifact of lung disease as well as trauma.  Gas build-up often  causes the lung to collapse under pressure.

Induced pneumothoraces were used to treat tuberculosis[2], impetus behind the founding of the American Lung Association[3], and the pet ailment of Edgar Allan Poe.  The concept was developed by Carlo Forlanini[4] in 1882.  Tuberculosis had been studied at least since the 11th century, but treatments for it ranged from crude to gruesome–and most of them ineffective–until the development of streptomycin[5] in 1946.  Tuberculosis remains a major health problem in much of the world, but until the mid-twentieth century was also a serious concern in the West, where it is no longer a disease that most people fear.

In the absence of effective drug therapy, treatment usually meant a stay in a sanatorium[6] (sanitarium), where rest, fresh air, and wholesome food were provided in the hopes that the weakened body would rally and fight off the disease.  Many people also moved to the drier southwestern states[7] to clear their lungs.  If dry air and sleeping on the porch[8] didn’t work, doctors might attempt surgical intervention.

The procedure[9] involved inserting a long needle between the patient’s ribs[10] and pumping the chest cavity with sterile nitrogen gas.  The theory behind the induced pneumothorax was that it would allow the diseased lung to “rest”.  In much the same way that a cut on the palm of the hand won’t heal if the hand is being opened and closed constantly, it was reasoned that a lung couldn’t heal under the constant irritation of inflation and deflation.  Collapsing it forced it to remain idle long enough to heal.  Obviously, only one lung was collapsed at a time so that the patient could still breathe.  From the old journal articles I read, it appears that the lung was left like this for months or even years.

Pneumothoraces required that the patient be in good enough condition that he or she could tolerate the effective loss of a lung for an extended period; it couldn’t be done on those who had two failing lungs.  It also required maintenance.  Patients had to visit their doctors periodically to be re-filled with gas.  In some cases, one lung might be collapsed until it healed, and then the other one collapsed once the first was back in working order.  A common complication arose when patients had adhesions connecting the lungs to the cavity wall, which had to be separated slowly and gently.

One article[11] I found gave the success rate as

Arrested (that is, the disease halted): 22%

Improved: 29%

Not benefited: 49%

I can’t tell from my reading to what extent the halt or improvement of the disease could actually be attributed to the pneumothorax.  It seems to have been considered quite effective at the time.  A 50-50 chance doesn’t sound very reassuring to me, but I guess it looks pretty good when you have nothing else to try.

Here is the other side, with the fill line.  I’m not sure what caused the staining (it’s not blood!  Get your mind out of the gutter.  Whatever it is, it’s deep pink in real life).

 

Made in Philadelphia by Geo. P. Pilling & Son.

 

“It is an easy instrument to understand and directions seem almost superfluous.”  Is that reassuring or not?

According to the directions, this appears to have simply pumped air into the thoracic cavity.  The outer cylinder is filled with water and air is basically pumped in by raising and then compressing the inner cylinder.  The U-shaped glass tube attached to the back is a manometer that monitors air pressure in the chest cavity.

It could also be used to withdraw air.

The manual says it was designed by Dr. Norman Bethune[12], who rates quite a biography on Wikipedia, and elsewhere.  The manual was copyrighted in 1942, so the machine is about 65 years old.

 

An older Cutler-Robinson type Pilling-Made Pneumothorax Apparatus[13], found in an abandoned hospital somewhere.

Another one[14].  Notice that the liquid in the right-hand jar has also precipitated.

Another one[15], in beautiful condition.  This type is also featured in the catalog that came with the one above.  I think it is probably the preceding model.

Davidson[16] apparatus, circa 1935.

Sources:

1, 2, 3, 5, 6, 12 – Wikipedia

4 – Museu d’Història de la Medicina de Catalunya.

7 – Weinzirl, John.  Public Health Pap Report, 1907; 33(Pt 1): 111–122.  Obtained via PubMed (National Library of Medicine).

8 – Image from the John P. McGovern Historical Collections and Research Center, Texas Medical Center Library, Houston.

9, 11 – Long, Esmond R. “Artificial Pneumothorax in Tuberculosis”, American Journal of Nursing, Vol. 19, No. 4, Jan. 1919.  Pages 265-268.  Obtained by JSTOR.

10 – Image from the U.S. Army Medical Department Office of Medical History.

13 – Opacity: Urban Exploration blog.

14 – Flickr: Evenshift///3 photostream

15 – Oregon Health & Science University Historical Collections & Archives.

16 – University of Arkansas for Medical Sciences Historical Research Center.