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April 7, 1945


JAMA. 1945;127(14):945. doi:10.1001/jama.1945.02860140062022

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To the Editor:—  In a recent report of a case of spontaneous pneumothorax (The Journal, March 3), Holter and Horwitz present certain statements which deserve comment.In considering the mechanism of the accident they propose that the precipitating factor was the drop in barometric pressure entailed in an ascent to 8,000 feet, "thereby creating a tendency for the lung to collapse partially" and, again, "... with the development of increased tendency to separate the pulmonary from the parietal pleura, a weakness in the pleura was exploited and pneumothorax occurred." Such an increased tendency toward pulmonary collapse on ascent to altitude would indeed be an important factor to consider, if it really existed. As a matter of fact, no such tendency exists.Under normal conditions the pressure in the potential pleural space is less than the intrapulmonary pressure by an amount which depends on the elastic recoil of the lung. The actual

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