The Management of Closed Chest Injuries.

From Grecian days up to modern times serious penetrating and other injuries of the chest have resulted, almost without exception, in the death of the injured person with the physician or surgeon standing by helplessly. Medical historywas made and recorded whenever a patient with severe chest injury recovered and these cases seemed mostly to be chest wall injuries with lung prolapse. Pare, that great surgeon of the Renaissance, was one of the first to recognize a traumatic diaphragmatic hemia. He also described a test for a penetrating wound of the lung. His revolutionary treatment of war injuries was well ahead of his time and is much to be admired even today. The last war saw a major step forward in the understanding and management of chest injuries and yet today, in a society in which chest injury is becoming an increasingly serious problem, the treatment of these patients is often left in the inexperienced hands ofjunior members of the medical staff who have had little or no instruction in the principles of chest management. It has been all too frequently the experience of the writer to be asked to see patients, often with relatively mild chest injuries, only to find their condition deteriorating because the principles involved in treatment have not been understood, and it is because of this experience that this paper is presented.