Medicine: Cushions for Lungs

Chicago’s old Iroquois Memorial Hospital sagged with the most influential politicians of northern Illinois last week. A simple lesson in anatomy and a mechanical treatment for tuberculosis drew them there. Specifically, a scrawny, tuberculous woman held their eyes. More specifically, the inside of her gaunt chest held their interest.

A member of the hospital staff, Dr. Minas Joannides, led the woman to an X-ray machine. Visible on a fluorescent screen were her slanted ribs, her heart behind her breast bone, and shadowy splotches which Dr. Joannides explained were her diseased lungs.

Each lung, the anatomy lesson went on, is contained in a flexible box made up of ribs on the outside, the.diaphragm underneath, and a partition called the mediastinum on the inside. Between those sides of the boxes and the lungs is an airtight cavity.

In the partial vacuum of those pleural cavities the lungs expand and collapse, expand and collapse with each breath. Sometimes infection inflames the lining of a pleural cavity, causes an exudation which fills the cavity and leaves no space for the lung to expand. In such a case of pleurisy, the fluid has to be drained off through a hollow needle carefully pushed in between a pair of ribs.

Sometimes a stab wound lets air into a pleural cavity. The air destroys the pleural vacuum which the lung requires and acts as a pneumatic cushion against which the lung can not expand. Such an accident is called pneumothorax.

In case of tuberculosis, pneumothorax may be a beneficial accident because it immobilizes the diseased lung, gives it a chance to rest and heal, and may enable the tuberculous invalid to attend his ordinary affairs. When doctors realized that good fact, they invented a procedure called artificial pneumothorax.

Dr. Joannides, an expert in artificial pneumothorax, last week proceeded to show the attentive politicians how it was done. An attendant scrubbed the gaunt tuberculous woman’s chest with alcohol. Dr. Joannides anesthetized a small area between two ribs. Then he took a jar of filtered air from a shelf. To the mouth of the jar was attached a soft rubber tube. To the other end of the tube Dr. Joannides fastened a large hollow needle. This he jabbed between the unflinching woman’s ribs, kept it there while the air sighed from the jar into the vacuum around her diseased lung. When he judged that the cushion of air was big enough to immobilize the lung, he withdrew the trocar. The slim hole between the ribs closed by itself.

The robust Chicago politicians, led by Mayor Edward Joseph Kelly, departed, proud that they had supplied the money to enable Iroquois Memorial Hospital to inaugurate what they believed was the world’s first pneumothorax clinic for the wholesale treatment of tuberculosis.