Simple spontaneous pneumothorax.

Riolan’ (1648), Littre2 (1713), Meckel3 (1759) and others in the 18th and 19th centuries reported air in the pleural cavity following trauma. In 1803 Itard4 called attention to five cases found at necropsy. He coined the term pneumothorax. Laennec (1819) discussed the clinical aspects of this condition and its recognition by physical examination. The writings of these authors alerted physicians and many reported cases. In fact, just a century after Itard’s thesis was published Emerson#{176} listed 358 literature references to this condition. During the past 50 years a vast bibliography has accrued with ever increasing knowledge of frequency, etiology, diagnosis and treatment. Air may reach a plueral space through the parietal pleura as in stab or bullet wounds or disease which penetrates the chest wall. Perforation of esophageal or gastric ulcers and subphrenic abscess may be responsible. Most frequently air is found in the pleural cavity as a result of willful induction in the treatment and diagnosis of disease. Air may also enter a pleural cavity through the visceral pleura. Anything that establishes a communication between bronchial ramifications or air cells and the pleural space permits this endogenous origin of air in the cavity. Injuries to the chest wall sometimes result in rib fragments penetrating the visceral pleura. Needling the chest for any purpose such as aspiration of fluid may puncture the visceral pleura. Resuscitation of newborn infants, passing a bronchoscope, administering intratracheal anesthesis, etc., are sometimes responsible. Hewson7 (1767) apparently was first to mention the possibility of entry of air into a pleural space through perforation of pulmonary diseases. It is now known that both acute and chronic disease may so damage the visceral pleura as to permit the escape of air into the pleural space. The term spontaneous pneumothorax has been reserved for those cases in which disease or defect of the pleura permits air from the lung to enter the pleural space. Earlier in the evolution of our knowledge of spontaneous pneumothorax this condition was usually recognized in persons who had pulmonary disease demonstrable during life or at necropsy. More cases were reported due to pulmonary tuberculosis than to any other disease, probably because of its prevalence and inadequacy of differential diagnostic procedures so that many nontuberculous pulmonary