Treatment of non-tuberculous spontaneous pneumothorax.

Non-tuberculous spontaneous pneumothorax is more common than tuberculous pneumothorax. During the last four years we have seen this accident occur in about 40 cases. During the year 1949 alone, one of us had the occasion to observe 11 cases, while, during the same period, he had only treated three cases of spontaneous tuberculous pneumothorax.’6 On the other hand, everyone at present agrees as to the cause of these so-called idiopathic pneumothoraces. Laennec already suspected the part played by the emphysema air bubble which Devilliers confirmed in 1826.12 Attention has again been drawn to this cause during the last 25 years by the anatomical and microscopic investigations of Fisher-Wasels,’3 Miller,20 and especially, Mariano Castex.7 We need not recall here the general study on non-tuberculous, spontaneous pneumothorax which we had outlined a short while ago;’9 we shall merely emphasize the clinical, radiological and pleuroscopic characteristics on which the mode of treatment may depend. Treatment is indeed conditioned by various factors based on the patient’s examination and clinical history. I) When one comes across a first attack and when the pneumothorax seems on the point of clearing up rapidly without treatment, no special measures are needed. Merely, in a few cases, one should promote pulmonary reexpansion by removing the intrapleural gas. It is only exceptionally that an operation will have to be considered at the first crisis, either owing to alarming primary symptoms which exsuflatlon is unable to control, or owing to the presence of lesions requiring radical treatment such as a voluminous air cyst. It should be emphasized that cases where a non-tuberculous spontaneous pneumothorax heals without treatment and runs a benign course are by far the commonest. 2) Frequent relapses of this accident call, on the other hand,