Management in Obstetrics

This complication of pneumothorax, when it does occur, is most often found in otherwise healthy men between 15 and 45 years of age (Calvert and Smith, 1955). Difficulty may be found in making the correct diagnosis. An acute abdominal condition is not an infrequent "first diagnosis" (Ross, 1952). In our case it was only after the finding of a pneumothorax on chest film that the true nature of the condition was suspected and later confirmed by thoracentesis. In the first instance, in spite of the pleural effusion, it was felt that duodenal hawmorrhage was the cause of the shock; an impression supported by the patient's history of indigestion. It has been pointed out (Sellors, 1945) that immediate and repeated aspiration, although decreasing the intrapleural pressure, does not restart bleeding and will prevent fibrothorax. Results in this case agree with this statement. Where bleeding does not stop spontaneously, blood transfusion and thoracotomy may be necessary. Clyne and Hutter (1955) regard the condition as a surgical emergency and go so far as to recommend emergency thoracotomy as the treatment of choice in all cases. Ttiis is the second edition of a book which has earned well-deserved populaLrity. It is intended for the general practitioner and gives advice on obstetrical management. This advice is backed by the wvide personal experience of the author, and the methods of treatment recommended are those which he personally has found most useful; a most imlportant feature. The book is delightful to read, and the quotations which head many of the chapters make one envy the author his capacity for remembering the apt phrase and his extensive klnowledge of English literature. It is a book which deserves a prominent place in every practitioner's 1.brary.