A CLOSED SYSTEM OF DRAINAGE FOR PENETRATING WOUNDS OF THE CHEST

No satisfactory system of drainage for infected war wounds of the chest has been employed that does not produce a more or less open pneumothorax. It is well known that open pneumothorax seriously disturbs the mechanics of respiration and circulation, and exposes large areas of pleural membrane to infection. It is well known also that open pneumothorax is very seldom cured spontaneously. Recent war surgery has demonstrated satisfactorily that the pleura is able to overcome a very extensive contamination and even a severe infection in a comparatively short time. But to do so the pleura must be in practically a normal condition otherwise, that is, free from accumulations of air or fluid. Patients operated on early and left with open drainage invariably have done badly. Patients not operated on have developed empyema or become septic. The middle ground offers the best chance, and patients operated on at a selected time