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To the Editor:—
In The Journal, March 3, Holter and Horwitz reported an instance of spontaneous pneumothorax produced by ascent in an airplane. In considering the mechanism of this accident the authors make the following statements: "Under normal conditions the pleural cavity is merely a potential space between the parietal and pulmonary pleura in which an average pressure of about 756 mm. of mercury is maintained. Again under normal conditions the intrapulmonary pressure is kept at approximately the same level. In this case the pressure was rather abruptly dropped to about 560 mm. of mercury or by about 26 per cent, thereby creating a tendency for the lung to collapse partially. As long as the pleural cavity remained potential, this would not have been possible. But with the development of increased tendency to separate the pulmonary from the parietal pleura a weakness in the pleura was exploited and pneumothorax occurred."
Engel GL, Ferris EB. SPONTANEOUS PNEUMOTHORAX AND ASCENT IN AIRPLANE. JAMA. 1945;127(14):944. doi:10.1001/jama.1945.02860140062020
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