Affections of the Respiratory System

affections of the nasal passages


Definition: This is nose-bleeding.

Etiology: When not due to a blow on the nose, nose bleeding is due to an excess of blood in the nose (hyperemia), or to nasal catarrh, or to high blood pressure, dysemia, anemia, uremia, fibrin deficiency in the blood, etc.
Young people who have nasal catarrh with irritation pick at the nose and scratch the nasal membrane with their finger nails. In time ulceration develops often causing necrosis of a blood vessel and profuse bleeding.
Nose bleeding often acts as a safety valve in apopletic subjects. The bleeding relieves some of the blood pressure and lessens the danger of a cerebral hemorrhage.

Care of the Patient: See Rhinitis and High Blood Pressure.


Definition: This is an acute, usually recurrent, and distinctly seasonal inflammation of the nasal mucous membrane sometimes extending to the conjunctiva of the eye, and the membranes of the pharynx, bronchial tubes and Eustachian tubes.
Symptoms: While defined as an acute inflammation which is subject to recurrent and seasonal acute exacerbations, the catarrh is continuous but is peculiarly subject to, pronounced increase in severity of symptoms in the months of May, June, July and August. In the South it may last all the year. Nasal obstruction with rhinorrhea and much sneezing are accompanied by congestion of the conjunctive, watering of the eyes, itching of the eyelids, nose and palate. There is headache and lassitude and, occasionally, paroxysms of asthma. It may be described as a severe cold running on day after day, with no let-up, and often growing worse, for the longer it persists in the acute stage, the more sensitive the mucous membrane becomes.

Prognosis: Complete recovery may be expected in six weeks or less in the vast majority of cases. A few cases persist longer than this time.

Care of the Patient: Running away from the external sources of irritation is merely a palliative measure. Going to dustless, pollenless, ragweedless, catless, horseless, chickenless, gooseless, sweatheartless and senseless resorts does not correct the underlying constitutional perversion — toxemia and its resulting catarrh. Hoping for the hurried coming of the old charlatan, practicing without a license, Jack Frost, to put an end to pollens, wastes a lot of valuable time and causes the sufferer to endure a lot of misery. Searing the nose, wearing air-filters, staying all summer long in air-conditioned rooms, going on sea voyages, etc., do not remove cause. Most of these palliatives are for the well-to-do only.
A fast for the removal of toxemia will end the catarrh in a very short time and remove all sensitiveness to pollen, dust, sweetheart, etc. Rest for the nervous system and a healthful mode of living will build up a high degree of health and prevent all future recurrence of hay fever. Following the elimination of toxemia, restoration of normal nerve energy and correction of the mode of living, the evolution into good health is sure and rapid.


Definition: This is inflammation of the nasal mucous membrane. Acute rhinitis is known as coryza, or colds; chronic rhinitis is known as chronic nasal catarrh. Catarrh is inflammation of a mucous membrane with hypersecretion of mucus.

Symptoms: Three varieties are classified as follow:

Simple Chronic Rhinitis: There are a mucoid or mucopurulent discharge from the nose, nasal obstruction from swelling or thickening of the mucosa or from inspissated secretion, mouth breathing, a nasal intonation of the voice and impairment of the sense of smell. The membrane of the nose is congested, swollen and highly irritable.

Hypertrophic Rhinitis: There is usually a secretion of thick mucus, the mucous membrane is red and the cavities are more or Less occluded from thickening (overgrowth) of the tissues covering the turbinated bones and the lymph-adenoid tissue in the nasopharynx is hypertrophied — adenoids. In advanced cases exostoses (bony growths) from the bones of the nose are seen.

Atrophic Rhinitis (ozena): This form is seen most often in young adults and more often in females than in males. The lining membrane of the nose is pale, dry and glazed. Adherent scabs are usually present. The nasal chambers are large, the secretion is very abundant, thick, and of a yellowish or greenish color. An extremely offensive odor, probably due to decomposition of retained secretions, is characteristic of this stage. Necrosis of the bones of the nose and sinking of the bones of the nose are seen in advanced cases.

Complications: Symptoms of catarrh of the neighboring chambers are commonly present. Dryness of the throat and hawking from pharyngitis, deafness from catarrh of the middle ear, watering of the eyes from catarrhal occlusion of the tear ducts, and dull frontal headache from sinusitis, are the most common of these symptoms.

Polyps (polypus): This is a smooth growth from a mucous surface, result of a local inflammatory hyperplasia (overgrowth), and is supported by a stem.

Etiology: Catarrh of the nose is one of the earliest manifestations of mucous membrane irritation; beginning in infancy with continuous and progressive changes in. the mucous membrane, it usually lasts throughout life. Enervation and excessive food intake are basic causes. Toxemia and indigestion are always precedent. Catarrh or fermentation in the stomach is always present though there are no digestive symptoms. Excesses of starch, sugars, fats and milk are especially likely to build catarrh. Men have more catarrh than women because they eat more, wear more clothing and dissipate more. Men enervate themselves more and have more toxemia.

Prognosis: Complete recovery in all forms may be expected upon removal of the cause. Polyps are readily absorbed by fasting and do not recur if the causes of catarrh are avoided.

Care of the Patient: This should be obvious. Stop all enervating practices, secure sufficient rest for nervous recuperation, fast long enough to eliminate toxemia and restore normal secretions and follow a healthful mode of living thereafter. Only by rigid adherence to this program can complete recovery be achieved. Only by right living can recurrence be prevented. Polyps will be absorbed during the fast and, if future catarrh is avoided, will not recur. The thickened membranes of the nasal passages will return to their normal thickness and the obstruction to breathing these cause will end. In atrophic rhinitis not all the wasted structures can be rebuilt
Definition: Edema of the glottis with inflammation — a rare but serious affection.

Symptoms: Difficult breathing which gradually increases in intensity, strikes fear into the patient and this increases the trouble.

Etiology: It is seen in scarlet fever, diphtheria and typhoid fever that is complicated by kidney impairment and albumen in the urine. It is, therefore, another, outgrowth of toxemia.

Prognosis: There is always danger of death from suffocation until the edema has begun to recede. Proper care should save practically all cases.

Care of the Patient: It is essential to stop all food at once, if this has not already been done. If the edema becomes great enough that suffocation is threatened, ice should be applied to the throat. If this fails, tracheotomy or intubation will be necessary to save life.
Definition: This is a spasm of the vocal chords excited by catarrh. If the larynx and swelling of its mucous lining. It is a common malady of early childhood.
Formerly croup was divided into membranous and non-membranous or simple croup. Dr. Trall thought the two croups differed only in degree and said "in the former case the exudation which forms on the mucous lining of the wind pipe (trachea) concretes into a membranous covering, and in the latter case, the excreted matter is expectorated without consolidation."
The differences in the behavior of the two exudates show a big difference in their characters, and point to differences in their causes. Simple croup is of a catarrhal nature and results from carbohydrate plethora; membranous croup is of a serous nature and is the result of protein poisoning.

Symptoms: Croup is a very alarming condition, but not serious. To be awakened about midnight from a sound sleep and find your child, whom you had put to bed apparently in the best of health, struggling for its breath, with shrill wheezy Inspirations, perhaps blue in the face, and coughing almost constantly, is enough to frighten any parent. It does not matter how frequently one sees croup, it never falls to produce a feeling of apprehension and terror. However, the, condition soon passes off, the child goes to sleep, and by morning seems as well as ever, giving one the impression that the whole experience was a, horrible nightmare.
Usually there is a little hoarseness and cough during the day, then, at night the child is awakened by a severe paroxysm of suffocative cough. The paroxysm usually comes on about midnight and manifests itself by a sharp, dry, hoarse, barking cough which is associated with evidences of dyspnea — anxious face, dilated nostrils, etc. In severe cases it is difficult for the child to breathe, the child making an apparently superhuman struggle for breath. During the paroxysm the skin is hot and the pulse is tense and rapid.

Etiology: Croup is seen largely in winter. Scrofulous and plethoric children are most subject to it. The fattest children are the ones who have the croup most. Many children have it every winter. But it is not due to cold, or exposure, or to wet feet and similar bugaboos. Croup is always the result of wrong feeding and bad hygiene. Children who are prone to have croup frequently are overfed on bread, potatoes, beans, cereals, sugar, syrup, jellies, jams, cakes, pies, candies, milk, greasy mixtures, fried foods, etc., and are housed in poorly ventilated homes. An overloaded stomach almost always precedes a paroxysm or croup. Breathing the hot, dry air from stove or furnace, tends to produce the condition. Many cases would never occur if the bed rooms were properly ventilated and stoves kept out of them.

Prognosis: This is always good.

Care of the Patient: There is no care which can do any good during a paroxysm except that of giving the child fresh air. Rot baths or hot cloths applied to the chest are the least harmful of the palliative measures in use, but even these are not necessary and are not curative.
The paroxysms last but a few minutes and the real treatment should consist in a reordering of the living habits and the surroundings of the child so that there will be no subsequent paroxysms. Recurring affections are to be "treated" during the intervals rather than during the recurrences.
All food should be stopped at once and nothing but water given for three full days. This is especially important since an occasional case of croup, which turns out to be the early stage of a fatal diphtheria, may be prevented from reaching a fatal stage by withholding food at once.
When the diet is changed and the home ventilated, croup ceases not to recur again. Children should not be permitted to, overload their stomachs at night, nor at any other time, for that matter. If there is a stove in the room a pan of water should be placed on it to keep the air in the room moist.
Definition: This is defined as an expiratory dyspnea that appears paroxysmally or intermittently, with wheezing, cough and a sense of constriction, due to spasmodic contractions of the bronchi and a swelling of the bronchial mucous membrane.

Symptoms: Asthma is preceded by chronic bronchitis and often by hay fever and sinus affections. The paroxysms may be preceded by such premonitory symptoms as oppression of the chest, mental depression, dyspeptic or other symptoms, or may come on suddenly, usually at night. The patient is unable to lie down, but is forced to sit up, often before an open window. The dyspnea becomes intense, the face is pale, the expression anxious, there is a great feeling of oppression in the chest and often a dread of suffocation. Though labored, respiration is not usually frequent, due to prolonged expiration. In severe or prolonged paroxysms there is blueness, sweating, cold extremities, small and frequent pulse and drowsiness. Paroxysms last from a few minutes to many hours and may pass off suddenly, perhaps to recur soon or on several successive nights, with slight cough and difficult breathing in the intervals; At first the cough is nearly dry and the sputum very tenacious. At the beginning the paroxysms may last only a few days, and recur at intervals of a few weeks or months, but as the condition grows chronic, the asthma becomes continuous.

Complications: Sinusitis, hay fever, bronchitis and emphysema are common complications. Emphysema develops only in protracted cases.

Etiology: The asthmatic crisis is a toxic storm, which occurs when the machinery of elimination is no longer equal to the load put upon it. From acute asthma the case is hurried to the chronic state. Then emphysema, bronchectasis and tuberculosis are logically expected to follow.
Asthma always means a catarrhal condition. But not all who have catarrh develop asthma. Only those with neurotic tendencies will have asthma. The non-neurotic may develop a severe chronic catarrh and never have asthma.
There should be no difficulty in understanding the condition. The asthmatic is an asthmatic long before the broncho-spasm puts a label on him and if once we grasp the, fact that in every case of' asthma there is a preceding history of disobedience of the laws of life, we are in line for rational care and ultimate complete recovery.
By uncontrolled impulses or emotions, business and domestic worries and other worries, lack of poise and self-control, sexual drain, overeating, improper eating, lack of sleep, sleeping without ventilation, overstimulation, etc., a state of enervation is built which checks secretions and excretions, and builds toxemia. Enervation plus wrong eating — too much food, wrong combinations of food, etc. — favor gastro-intestinal decomposition and this adds the enervating influence of auto-intoxication to the prior weakening habits.
Asthma is brought on in the first place from excessive table indulgence, plus many other nerve leaks. The enervating effects of over-feeding and physicking may produce asthma in children. The abominable habit of physicking children during infancy and early childhood is responsible for many other conditions besides asthma.
Most medical writers of the present ascribe bronchial asthma to "protein hypersensitiveness." These writers do not pretend to know the cause of hypersensitiveness, or allergy, as it is called. Asthmatics are roughly divided into two classes:

(1) Those sensitive to ingested substances — oysters, meat, eggs, etc.

(2) Those sensitive to air-carried irritants — pollens, emanations from horses, cats, dogs, feathers, dust, etc.

Those sensitive to air-carried allergens rarely absorb a quantity sufficient to give rise to general symptoms; whereas, in sensitization (allergy) to food, symptoms of general reaction are common. In some, the general sensitiveness to food causes a chronic irritation of all the organs of the body, but that organ or part of the body which is the weakest link in the chain will be the one to develop "disease" first. If the tendency is to asthma, then the chronic irritation produced by allergens will evolve asthmatic symptoms if and when the poison so produced is sufficient to cause reaction.
Protein hypersensitiveness (allergy) is merely another name for protein poisoning, or what amounts to the same thing, protein stuffing, in those of a neurotic diathesis.
Asthma rests on a basis of toxemia and catarrh, and the dog, cat, horse, feather pillow, pollen, etc., have nothing to do with its causation. "Hot dogs" are the only "dogs" we know of that have anything to do with producing asthma.
The immediate cause of the bronchial spasm is an irritation of he nerve-endings of the vagus nerve which supplies the bronchi. In some cases even water taken into the stomach will so irritate the vagus nerve in the stomach that a direct reflex irritation of the vagus nerve in the lungs induces an asthmatic paroxysm. In the same way, drugs, some foods, gas and indigestion occasion reflex irritation of the nerve-endings in the bronchi and bring on a paroxysm of asthma. Breathing cold air, dust, pollens, gases, foul odors, and other such things, produces a direct irritation of the nerve-endings in the lungs and brings on the paroxysm.
If water, irritating foods, drugs, indigestion, cold air, dust, pollens, foul odors, gases, etc., were primary and direct causes of asthma, nobody would be free of this condition. The real, the basic, cause of asthma is that which sensitizes the nerves and the bronchial membranes. Asthma rests on a basis of toxemia and gastro-intestinal catarrh. If asthmatics were not enervated and if their bodies were not filled with toxins to the saturation point, they would not be hyper-sensitive to proteins and other substances.
In asthma there is an abnormally sensitive perpheral organ —the ethmoid area of the nose — and this is often operated upon or seared. This abnormal sensitivity should be regarded as an effect of the chronic overload of toxemia and not as a cause of asthma. Crippling the nose does not cure asthma.
Dr. Oswald says: "Any waste of vital power may bring on a fit of spasmodic asthma, and the aggravating effect of incontinence is so prompt and so unmistakable that experience generally suffices to correct a penchant to error in that respect. Like gout, asthma is a moral censor, but its reproofs do not so often come too late."

Prognosis: ALL cases of bronchial asthma are remediable. Five to six weeks are sufficient time for complete recovery in the average case. More time is required in a small percentage of cases.

Care of the Patient: Eliminate toxemia, restore nerve energy and correct the mode of living. The fast should last until all abnormal breath sounds have disappeared from the lung; preferably, it should last until the tongue is clean. Two to four days of fasting is usually enough in even the most severe and long-standing cases to bring sufficient relief to allow the patient to lie down and rest and sleep.
When the underlying toxic condition is eliminated, all forms of sensitization disappear. When the asthmatic gets rid of toxemia he does not have to worry about sensitization. He automatically gets rid of this when he gets rid of the true cause — toxemia. It is, perhaps, true that all asthmatics will retain to some extent their sensitiveness to certain foods, chemicals, heat, cold, etc., as they originally had that tendency or diathesis when they were born, but by following a few simple rules of right living they may always avoid a recurrence of asthma.
It was pointed out above that the immediate cause of the bronchial spasm called asthma is an irritation, direct or reflex, of the nerve-endings of the vagus nerve which supplies the bronchi. A hyper-tonicity or vagotonic condition is induced by the irritating effect of the poisons of toxemia upon the vagus nerves and in this way the bronchi are thrown into a spasm. The asthmatic sufferer is in a chronic state of delicate balance between absorption and elimination. Anything that helps to throw the balance in favor of elimination helps to relieve him; anything that throws it the other way increases his distress. This is the reason it is so necessary to avoid all those practices that enervate and intoxicate the whole organism. Allowing the feet to become cold is often enough to bring on a paroxysm of asthma, and a paroxysm is often relieved merely by warming the feet. In asthma, tonsilitis, bronchitis, and tuberculosis it is necessary to "temper the wind to the shorn lamb."
Few asthmatics have much idea of their limitations in eating, working, enjoying, etc., and, as a consequence of their over-indulgence, are constantly adding to their trouble. If they are to get well and remain well, they must learn self-control.
In consequence of the contraction of the finer bronchial tubes and the air-cells of the lungs, air cannot be got into the lungs, and the entire volume of blood cannot be sufficiently oxygenated and purified The difficulty in breathing prevents rest and sleep, often making it impossible for the sufferer to recline. The palliative treatment commonly employed adds greatly to enervation and thus to toxemia. The original causes are not corrected. Under such conditions, how can recovery be hoped for?
Definition: This is dilatation of the bronchi.

Symptoms: Paroxysmal cough, dyspnea and copious expectoration are its chief symptoms. The expectoration is characteristic — a large amount of extremely fetid mucopurulent sputum is expelled from time to time, especially in the morning or on a sudden change of position. On standing the sputum separates into three layers: — an under layer of decomposed pus; a middle layer of turbid mucus; a top layer of discolored froth.

Sequa1ae: Abscess or gangrene of the lung, abscesses of the brain and in various locations especially in the body, and amyloid "disease" of the viscera, are common sequels.

Etiology: This is secondary to other pathologies. It follows chronic bronchitis most frequently, due to the weakening of the walls of the bronchi by the prolonged inflammation and the increased pressure from the violent coughing. In children it sometimes follows bronchopneumonia. It is seen in other cases as a sequel of interstitial pneumonia, tuberculosis, chronic dry pleurisy, and in bronchial obstruction by a foreign body, aneurysm, tumor, etc. The intelligent reader will readily see that it is only another link in a pathological chain resting on toxemia.

Prognosis: Perhaps complete recovery is not possible. However, great improvement is possible when toxemia and the primary pathology are removed and a health building regimen is followed.

Care of the Patient: See Chronic Bronchitis and Chronic Pneumonia.
Definition: An abscess is a localized collection of pus in a cavity formed by the disintegration of tissue.

Symptoms: Rigors, sweats, fever and pallor indicate suppuration. Coughing, difficult breathing and the expulsion of purulent, offensive sputa containing shreds of tissue indicate that the lungs are the locale of the suppuration.

Etiology: Lung abscess is sometimes, though rarely, a sequel of pneumonia. Abscess is frequent in tuberculosis. It may, result from the lodgement of foreign matter in the bronchi or from the extension of suppurative inflammation from the pleura or liver. Some cases are due to blood clots (emboli) and are of common occurrence in pyemia. Embolic abscesses are commonly multiple and are rarely recognized during life. Lung abscess is a terminal symptom in a long chain of pathology that rests upon toxemia.

Prognosis: Embolic abscesses are said to be always fatal. Many abscesses due to other causes recover.

Care of the Patient: Sometimes surgical drainage of the abscess is possible, but in most cases dependence upon good hygiene is the only recourse. The toxic load should be taken off the body by physical, physiological and mental rest. The patient with tuberculosis or liver abscess should be cared for as directed for these affections.
Definition: This is an effusion of serous fluid into the air-vesicles and interstitial tissue of the lungs. It is a very rare condition and may be appropriately called dropsy of the lungs.

Symptoms: These come on suddenly with a feeling of oppression and pain in the chest, rapid breathing which soon becomes difficult and sometimes impossible in any save the upright position. There is blue-ness and an incessant short cough with a copious, frothy, sometimes blood-tinged expectoration, which may be expelled in a gush from the mouth and nose. The face is pale and covered with a cold sweat, the pulse is feeble and the heart action weak.

Etiology: This is almost always a terminal symptom in advanced pathology of the heart, arteries, liver, kidneys, and in many acute and chronic states. It is often part of the general dropsical condition seen in heart affections, Bright's "disease," and malnutritional edema. It is seen in passive congestion of the lungs, and in ether anesthesia and in surgical puncture or tapping of the chest wall. Localized areas of edema are noted around circumscribed lesions of the lungs in tuberculosis, pneumonia, infarct, etc. Edema of the lungs is an end-point in a long pathological evolution growing out of toxemia, enervation and wrong life.

Prognosis: Death may result in a few hours, or the crisis may last twelve to twenty-four hours and then pass off. If it is not too far advanced and the primary pathology can be remedied, recovery may occur.

Care of the Patient: Since pulmonary edema is a complication secondary to Bright's "disease," cardiac decompensation and malnutritional edema, permanent recovery depends upon recovery from these antecedent conditions. Temporary recovery from the edema is often possible, but recurrences are common unless the primary pathology is removed. A physician of Glasgow, Scotland, reported seventy-two recurrences of pulmonary edema in one patient in two and a half years.
Weger says: "We have had gratifying results in a few cases which were treated before the entire lung structure became engorged." No food should be given so long as there is any trace of the edema. Water should be sipped sparingly. All enervating influences surrounding the patient must be removed. It may be necessary to allow him to sit up in bed in order that he may breathe. The windows must be open and the patient must be kept warm.

Tilden recommends a hot bath in water as hot as can be borne, with cool water on the head and cold water to sip, the patient to be returned to the bath every three hours if necessary and remaining in the water as long as possible, until permanent relief is secured. This is a purely palliative procedure intended to relieve the lungs and cannot be given to One suffering with serious heart "disease." If repeated often it becomes very enervating to the strongest patient and should, therefore, be used only where relief is not obtained by fasting, rest and fresh air.
Definition: This is pus in the pleural sac.

Symptoms: Empyemia presents the same symptoms as acute pleurisy, the fever rarely running higher than 102 F. The fever declines, but after a week or two the patient fails to show the expected improvement. Rarely does the patient complain of oppressed breathing until a great quantity of pus has accumulated. There is much oppression, chills, fever, and other indications of pus poisoning. Some cases carry pus a year or two before it is discovered. In such cases the patient will cough up pus.

Etiology: Empyemia may result from acute or chronic pleurisy in those of low vitality; but most cases of empyemia are septic from the beginning. Medical authors say empyemia follows "infectious diseases," particularly scarlet fever. It is the Hygienic view that putrefaction of food in the intestine, with consequent putrescent absorption, is the source of the necessary infection. All so-called septic and infectious "diseases," we hold, are made possible by a decided septic infection of the blood through absorption of putrefaction in the bowels.

Prognosis: This is guardedly favorable.

Care of the Patient: Aside from proper general care, fasting, proper feeding, rest, bathing, etc., in keeping with the patient's general condition thorough drainage is essential. The pus must be removed. This is a surgical procedure — that of aspiration — and should be done by a competent man.
Symptoms: Acute. Pleurisy begins with a chill, bone-ache, a sharp pain that nags the patient in the side, making it painful to cough, a dry cough, painful breathing and a rise in temperature. Pulse is rapid and there is a little expectoration that is sometimes frothy and colored. This expectoration indicates lung involvement — pleuro-pneumonia.
Sometimes the pleurisy runs an "insidious form" and ends in abscess. In these cases there is a decline in the first symptoms, but the patient will come to a standstill and remain about the same for a week or two weeks. The symptoms will not be severe, but slight fever will persist. Examination will reveal the presence of a pleuritic abscess.

Chronic. The symptoms of chronic pleurisy are practically the same as those of acute pleurisy except that they are of less intensity and longer duration. The pain is sometimes referred downward to the abdomen or upward to the shoulder.

Etiology: So-called idiopathic pleurisy, that is, pleurisy that is not secondary to some other affection, follows exposure and sudden changes in temperature, but only iii the toxemic. Secondary pleurisy develops as a complication of pneumonia, rheumatism, scarlet fever, tuberculosis, typhoid fever, puerperal fever, etc. Chronic pleurisy may follow one or more acute pleuritic crises, due to unabsorbed exudate, adhesions or a tubercular state.

Prognosis: This is good in all cases except that existing in advanced tubercular states.

Care of the Patient: This depends upon cause. As a rule the exudate is absorbed within a few weeks. Fasting hastens its absorption. In occasional cases, aspiration is necessary. Recovery can be achieved only by correcting enervating habits, eliminating toxemia, amid ordering the mode of living in conformity with the laws of life. Those with tubercular symptoms must avoid strenuous or exacting activities and learn to live to keep their energies high and their toxins low. Pleurisy that is secondary to other affections requires no care different from that employed for pneumonia, scarlet fever, etc.
Definition: This is air or gas in the pleural cavity.

Symptoms: These come on suddenly with localized pain, urgent dyspnea, cough, fall in temperature, feeble pulse, and even a condition of collapse. If the air is confined by adhesions or effusion there may be no special symptoms.

Etiology: Pneumothorax results from perforation of the lung by a tubercular ulcer, lung abscess, lung gangrene, emphysema, or a penetrating wound of the chest. About 90% of cases result from tubercular abscess. The present method of collapsing the lungs in T. B., by artificial pneumothorax cannot be too strongly condemned.

Prognosis: Regardless of cause, these cases are always serious. Death may result in twenty-four hours or in a few days to a few weeks. Tubercular cases rarely recover. Cases due to trauma or to emphysema are more favorable.

Care of the Patient: Removal of the primary pathology is the prime need. Aspiration may remove the air. Dr. Tilden says: "It would be well to put a tube into the pleura and keep it there as long as necessary."