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Forlanini's artificial pneumothorax apparatus
The same year Robert Koch (1882) identified the germ and established
the infectious-contagious nature of tuberculosis, Carlo Forlanini
defined the theoretical basis of artificial pneumothorax,
understood as a surgical therapy against the lung form of
the disease. Among the array of measures to fight against
the disease that was decimating the European population, the
main treatment for lung tuberculosis was, until middle of
the 20th Century, artificial pneumothorax, one of the methodologies
constituting respiratory failure therapy.
Forlanini’s theoretical proposal was indebted
to a long historical tradition: artificial induction of pneumothorax
for the draining of the pleural space was already considered
in the Corpus Hippocraticum. Pneumothorax experimentation
on animals and the observation of an improvement of tubercular
injuries in human lungs when spontaneous pneumothorax took
place, described in the first third of the 19th Century, yielded
an array of experimental interventions which slowly provided
the basis for thoracentesis, thoracotomy and thoracoplastia.
The operations and clinical experiments carried out at the
end of the 19th Century came to confirm and improve the technique
described by the Italian physician, officially recognized
on 1912. In Catalonia, Riba de Sanz, Jacint Reventós
and Lluís Sayé, thus yielding an interesting
medical literature on description and transmission of these
practices in the following years, performed the first operations
on 1911. It was at this time when the pneumothorax apparatus
we show was circulated and became part of the therapeutical
set of instruments before certain signs of lung tuberculosis.
Forlanini’s artificial pneumothorax apparatus had a
portable design and consisted in a system of glass communicating
vessels connected to a three-step key. A Richardson’s
bulb pushed water and nitrogen gas through rubber tubes towards
the pleural cavity, crossed by a Saugmann’s sterilized
needle with a mandrel, and communicated the glass vessels
with a water manometer, allowing regulating the pleural pressure
and the amount of air blown into the cavity. The application
of therapeutical pneumothorax was carried out once every 10-15
days for 3-4 years, thus renewing air injection into the pleural
cavity with the aim to achieve cicatrisation of injuries.
The technique was perfectioned thanks to X-rays and the creation
of radiological rooms, thus allowing an accurate follow-up
of the procedure through the visualization of the damaged
lung. This required the training of physicians specialized
on pneumothorax since the 1920s, with a stable array of patients.
The combination with antibiotics by the middle of the 20th
Century extended a few more years this technique until its
gradual discard through the 1960s.
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