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tween those due to traumatism and those due to empyema. A smaller number of cases are due to gangrene of the lung, to infarct, to abscess, to hy- datid, to bronchiectasis, to malignant disease, and to emphysema, while a number of cases are reported as coming on during some great muscular effort, such as running, boxing, rowing, etc. Incidence of the Condition. — Thirty years ago pneumothorax was considered a medical curiosity, and its discovery during life was considered a mat- ter for self-cougratulation by the clinician. It is only since 'the more general adoption by the pro- fession of systematic physical examinations of pa- tients, which examinations were rendered necessary to correlate the signs noted during life with the find- ings at the autopsy, that its recognition has become Aygestin Online easy and frequent. As a result of gathering together the statistics of several Norethindrone Acetate Tablets thousand cases of pulmonary tuberculosis with autopsy findings it has been found that 5 per cent, of all cases dying of tuberculosis develop pneumothorax. Aygestin Tablets Many reports from special hospi- tals for Aygestin 5 Mg tuberculosis give a much higher percentage than this, as instanced by the report of Dr. W. B. Stanton for the first two years of the existence of the Phipps Institute of Philadelphia. In this re- port 9 per cent, of all cases dying of this disease developed pneumothorax. Weil in 355 autopsies found 10 per cent. Emerson reports the propor- tion occurring in the Johns Hopkins Hospital as 3 per cent. The Brompton Hospital at London Aygestin 5mg re- ports 1,700 cases of phthisis with 3 per cent, of cases having pneumothorax. In the Philadelphia Hospital during the year 1906 there were twentv- one cases, or 6 per cent, of all cases dying of tuber- culosis. This average of 6 per cent, represents the acci- dent in only the tuberculous cases, while it is by no means unusual to see and hear of cases due to other causes, and this makes Aygestin Cost it seem reasonable to believe that many of the cases due to traumatism or those which occur as the result of faulty technique during the aspiration of fluid from the chest or those which occur during operations upon the chest wall, are not reported and thus the true frequency of pneumo- thorax is not known. Case I. — The first case to be reported occurred in a patient in Dr. Stengel's wards in the Philadelphia Hos- pital. The patient was a negro laborer, aged about thirty years. His health had always been good, so much .so that he could not remember having consulted a physi- cian. For a few months before the present illness he had noticed a slight morning cough which he ascribed to " catarrh." On the day the pneumothorax devel- oped the ])atient was at his work of unloading a car load of bricks. While stooping at his work he began to cough and brought up a small quantity of blood. One of his fellow workmen seeing the blood suggested that the patient had consuiuption, which suggestion so amu.sed the patient that he gave a hearty laugh, and at that moment was seized with a severe juiin in his left side. He was faint and unable to stand, so sat down beside his cart. After a time he made an attempt to resume his work, but was compelled by dyspncea, pain and dizziness to be taken home. When seen about an hour later the patient was still suffering great pain as well as from shortness of breath. The patient Generic Aygestin ven- tured the opinion at this time that he had "busted his lung,'' and when asked why he said this he said that he had seen " another nigger get caught in the same way while lifting a heavy box." On examination the patient's self-diagnosis proved correct. The chest showed great difference in .the size of the two halves. The left was much distended, the inter- spaces .were far less marked than were those on the right side, the left chest was immobile, while the breathing was rapid on the right, while on percussion a loud pitched sound could be heard over the entire left chest and far beyond the normal limits Buy Aygestin Online of reson- ance. The heart was displaced to the right, and the apex beat could be felt an inch beyond the mid-ster- num. The percussion note over the region normally occupied by Buy Norethindrone Acetate the apex of the heart was quite as reson- ant as the rest of Buy Aygestin the left side. On auscultation Buy Cheap Aygestin over the affected' lung no breath sounds could be heard, while over the right lung the breath sounds were Aygestin Price much exaggerated. The coin test was positive to a marked degree. There was no sign'of fluid in the chest at this time. The patient's pain was relieved by a hypodermic injection of morphine. There was no decided sign of shock, nor was the patient short of breath except upon exertion, and there seemed no good reason for inter- fering with the air in the pleura. Twenty-four hours after the accident the patient no longer suffered pain, but was still short of breath on the slightest exertion. Examination of the right lung showed no tuberculous lesion. The respirations were thirty-six to the minute, and at the base of the

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