Compliments of the Author. 
TRACTION PLASTERS FOR TEMPORARILY 
CONTRACTING AN AFFECTED LUNG, IN 
LIEU OF THE MURPHY OPERATION. 
BY CHARLES DENISON, A. M., M. D., DENVER. 
M.v object in presenting this paper is to offer and illustrate 
a better way than has heretofore been obtained to control tho- 
racic movement on one side and confine respiration to the unaf- 
fected lung. This method is a perfectly evenly, and easily ap- 
plied means to nearly annul the use of one lung, and therefore 
temporarily a suitable method to arrest pulmonary hemorrhages 
when from a known localized source; a way also to control ordin- 
ary or tubercular pleurisy, complicated or not with adhesions 
and pneumonia; or to limit and contract a pulmonary cavity 
especially if located low down in a lung. Here the descent of 
the diaphragm in breathing disturbs and over-distends a cavity 
and thus produces strain and rupture of implicated blood vessels. 
Messrs. Seabury & Johnson of New York have succeeded in 
making for me the special form of plasters desired, and the 
following is an illustration of what we will call a set or pair. 
These traction plasters are made suitable for use on either half 
of the thorax, and the collar is made to encircle the opposite 
shoulder. 
The plasters are spread on the attachable surfaces A to B. 
as shown in the cuts, of strong muslin so thick and firm that it 
will not wrinkle on pulling. They are large and long enough to 
tit a good sized man, all requirements of smaller sizes being pos- 
sible by paring these* down to the required dimensions. The col- 
lar, too, can be cut and made smaller very easily. These traction 
plasters when applied, lapping over each other in the axillary 
region, completely encircle the side to be compressed. The 
source of power for traction being above and out of the way of 
the other lung, that one is left temporarily to do the re- 
spiratory work of both lungs. This in a good measure it 2 
does do according to the accompanying test measurements. Note 
the illustrations of the application of the plasters on a 15-year- 
old boy who has grown seven inches in a year, and there- 
fore his chest can be assumed to be very flexible and yielding. 
His natural chest movements are: Circumference, 29f and 33f 
inches, or If inches expansion, the right being 15f and 17 inches 
and the left 15 and 16f, each side approximately If inches. (My 
explanation of the usual inequality between the circumferential 
movement and that of the combined two sides measured sepa- 
rately is that in the latter instance the skin may move and the 
measuring tape has a tendency to follow the upward movement 
RIGHT FRONT AND LETT BACK 
UA/SPREAD POPr/O/y 
Collar for 
OPPOSITE SHOULDER 
of the underlying ribs.) Now with the plasters on the left side 
and drawn tight, this youth’s measurements are: Total, 29£ and 
31f, or 2f inches; left, 15 and 15|, and right 15£ minus and 
inches, or over 2 inches, showing conclusively that the work is 
thrown onto the unbound lung. 
For comparison I chose a mature, fine chested, and hard 
working teacher of Swedish gymnastics and applied the plaster 
to the same side, the left. Total measurement, 33£ and 37; right, 
and 18|, equals 2; and left, and 18, equals inch. Plas- 
ters off, total, 33| and 38 inches; right, 16£ and 18£, equals 2; 
left, and 18|, equals If. Considering that the strength of 
expansion was so great in this trial that the safety pins gave 3 
way, the limiting power of Ihe plasters when applied to an 
invalid will be easily comprehended. In fact the comfort of the 
patient will often have to be conserved by not pulling the plasters 
toward the collar as tightly as possible. 
The most serviceable application of these traction plasters 
seems to me to be for the checking of pulmonary hemorrhages. 
Only inferentially suggesting the damage possible where a 
mistake is made in the application of this method, due to wrong 
reasoning as to where a pulmonary hemorrhage comes from, I 
will say that, when rightly applied, no other plan, in my judg 
merit, surpasses this one in the surety of result and tin* confi- 
Front 
Rear 
Right 
R/ght 
Left 
Left 
donee given both the patient and physician. The application of 
lhis method is most suitable when the diagnosis unmistakably 
points to the usual engorgement of blood which Niemeyer, I 
believe, was the lirst to intelligently explain. (I never felt sure 
my students understood this till they could explain why and 
how the blood of a pulmonary hemorrhage is arterial [red blood] 
and not venous as in engorgement elsewhere.) 
I wish to call attention to the frequency with which this 
engorgement and rupture occur in the left infra-clavicular space, 
and I will illustrate the good effect of the method of treatment 
by the following case: 4 
In February, 1895, I was called in consultation by Dr. White 
of Trinidad, Colo., to see C. L. W., who had had repeated pul- 
monary hemorrhages occurring every two or three days for over 
two weeks. The recurrence was not checked by the usual 
astringent and anodyne treatment which had been properly ad- 
ministered, mostly by hypodermatic injections. The patient, a 
tall Virginian, who had come to Colorado eight years previously 
after four years of ill health (hemorrhages, etc.), was pretty 
thoroughly exhausted by the loss of blood and the apparent hope- 
lessness of arresting the same. There was dullness on percussion, 
obstructed breathing, and moist rales on coughing in the left 
infra-clavicular space, and I concluded that the recurring hemor- 
rhages came from a spot half way between the center of the 
clavicle and the left nipple. Evidently as soon as he could make 
enough blood to supply the previous loss and get strength enough 
to cough and clear out the congested spot, a reopening of the old 
source would occur and he would fall back, a little weaker per 
haps than before. 
The plan I had previously tried in similar cases was readily 
acquiesced in, namely: 
Two strips of raw adhesive plaster, live by fourteen inches, 
were sewn end to end to similar strips of muslin, and a collar for 
I he right shoulder was made. The plasters were applied to the 
chest, crossing each other in the left axillary region, and the mus- 
lin, front and back, was tightly drawn and firmly pinned to the 
collar. The confidence which this support gave the patient 
augured success for the method, and the recovery was unevent- 
ful without any other treatment. 
Another illustration of a more prolonged management of 
such a case where the hemorrhages were from a large excavation 
is summarized as follows: 
Mr. M., July, 1892, age 33, a Kentuckian, who had been in 
Colorado seven years. Naturally of strong constitution and no 
inheritance to consumption, but very sick in childhood, “whoop- 
ing cough, lung fever at times and bronchitis for twenty-nine 
years.” Erysipelas nine years previous to date given. Came to 
New Mexico in 1870 from Kentucky; back and forth, east and 
west, his wayfaring life led to complications along in the nineties. 
In November, 1891, had grippe and then recurring hemorrhages; 5 
and in December was confined to bed and was three months in 
hospital with more hemorrhages and a profuse purulent bronchor- 
rhoea. In March. 1892. went to San Antonio, Texas, but had 
hemorrhages there. On return to Denver was confined another 
month with constantly recurring hemorrhages on the least exer- 
tion. and was pretty well discouraged and unable to leave his bed 
when I first saw him in June, 1802. A large bronchiectatic cavity 
was found in right infra-scapular region reaching up into the 
inter-scapular space, and another small bronchiectatic spot simi- 
larly located in lower left inter-scapular region from which In? 
bled in the following August. The hemorrhages from the right 
large cavity in May were, to me, explained by the strain produced 
in the descent of the diaphragm on deep breathing or coughing. 
The modus operandi of the mechanical means of relief depended 
on are easily understood on that basis. The hemorrhages were 
controlled without medication by the use, first, of plasters as 
described in the preceding case, then, later, by a jacket which was 
finally modified to a corset with straps and buckles (see cut), 
which he refused to go without for two years. Whenever any 
blood spitting occurred while out on the street he would step 
aside in an alley and pull up his straps and thus arrest it. 
The second illustration shows the approximate size and loca- 
tion of the cavities and their change under the compression treat- 
ment. I ought to add that this is the same case as No. 2, re- 
ported to the American Medical Association meeting in 1898, in 
my paper on “The Modern Treatment of Tuberculosis,” to whom 
were administered such large doses of crude tuberculin; for the 
case was tubercular, as proved by abundant tubercle bacilli found 
in his purulent expectoration. 
The management of these cavity and bronchiectatic compli- 
cations of lung disease necessarily introduces the consideration 
of the question of intra-thoracic. air pressures, a subject I haw 
been much interested in.* Such a study naturally brings under 
discussion the operation elaborated and illustrated at the Den- 
ver meeting of the American Medical Association by Dr. J. Ik 
Murphy of Chicago. This is to annul the action of the affected 
lung by injecting nitrous oxide gas into the adjoining pleural 
cavity. 
♦See “Abnormal Intra-Thoracic Air Pressures anil Tlieir Treatment,’- president's ad- 
dress, Denver meeting, September, 1890. the of American Climatological Association. 6 
As I am opposed to this method of procedure, because it 
seems to me to be an uncalled-for surgical operation, I will tala* 
this occasion to explain why the theory which actuates this inter 
ference with nature's processes seems to me indefensible as a 
general postulate. At most it can only be defended as an ex- 
ceptional advantage. 
While it is true that a diseased lung, when acutely affected 
and painful, can be healed and treated better if it is rendered 
inactive, yet it is also true that the life of the lung is its activity, 
and unrelieved compression will soon annihilate the use of a 
given lung. This surgical operation, to be successful, should be 
Front 
Rear 
Hemorrhage 
FROM HERE 
A1/6 '12 
bused upon a more searching and thorough physical diagnosis 
than I suspect is generally made by physicians and surgeons. 
My own experience has proved to me that both lungs are affected 
in a much larger percentage of cases than generally believed, 
and this operation depends upon one lung being in a normal 
condition. The “putting to rest” of the diseased portion of a 
lung is to be obtained by the possible annihilation of the re- 
mainder of that lung. Nature’s protective pleuritic adhesions 
and peripheral fibroid process, the evident purposes of which are 
to stiffen and support the affected portion, throw nearly all the 
contracting process possible to occur upon the unaffected por- 
tion operated on. This was the impression confirmed into a con- 7 
viction by the first Murphy operation I saw performed in Chicago 
last summer. The sacrificed good lung may, perhaps, afterwards 
be redeemed to some use; but the risks are too great, and the 
main object of treatment, the elimination of tuberculosis, is 
ignored. 
The teaching of a quarter of a century of experience on the 
part of the medical profession is controverted by the general ac- 
ceptance, if it were possible, of this theory. If that medical ex- 
perience cited has elicited and proved one thing more than an- 
other in our tight against pulmonary tuberculosis, it is that high 
altitude, exercise, and a proper method of inhaling, which, to my 
mind, involves exhaling against pressure, constitute the best 
means possible to limit this disease. Why? Because in curable 
cases these means open up to the inhaled, pure, or antiseptic air 
the affected lung areas which the proposed operation is intended 
to close. The operation is not without other dangers to the indi- 
vidual aside from the imprisonment in unventilated spaces of 
septic material; for instance, the shock to the system and the 
liability of wounding the healthy lung in the procedure. In 
those cases where it is evidently required to “put to rest” tem- 
porarily a portion or the whole of the lung, the method I have 
described can be applied with much certainty of obtaining bene- 
ficial results. 
The mechanical condition within the thorax needs to be rec- 
ognized as one of negative pressure, i. e., it averages much more 
on that than on the side of positive air pressure. During inspira- 
tion it is decidedly negative, and only positive during expiration, 
voluntary exertion excluded. But with voluntary effort included, 
inspiration is even more less positive than is expiration, as shown 
by our usual ability to expel about twice as much force, recorded 
in millimeters of mercury by the manometer, as we can draw 
into fin1 lungs by forced inspiration. The total physical state 
within the thorax is then negative throughout life, as stated by 
W. Einthoven and confirmed by W. N. Northrop, W. Oilman 
Thompson, tin1 late Joseph O’Dwyer, and others. 
This is most important—the chief—of all considerations to 
be kept in mind by the surgeon who undertakes to operate 
through the thoracic walls to reach any cavity or air space con- 
nected with the bronchial tract. It is undoubtedly the explana- 8 
tion of more than one sudden death, resulting from ill-advised 
effort to aspirate a bronchiectatic or other cavity within the lung. 
The difficulties and dangers which this consideration im- 
poses upon surgical interference with the respiratory organs, 
with their delicate vascular supply quickened commensurate to 
their small area compared with the many times greater area of 
the systemic system, were the incentives for devising, firsr, a 
rapid way to enter the chest wall by resection of a rib; and, 
second, a drainage tube which would control the ingress of air 
and so counteract this negative pressure. The rib cutter and the 
valvular drainage tube which I presented to the profession sev- 
eral years ago answer these purposes very nicely. The former 
gives ample power to one hand, after an inch and a half incision 
is made over a rib, to make a clean excision of one to three inches 
of a rib; and the immediate introduction of the latter, following 
puncture with a blunt instrument, is possible, so that no fearful 
aspiration inwards of the contents of a bronchiectatic cavity can 
occur. 
In conclusion, it is evident that this negative pressure state 
within the thorax aids the permanent shrinkage process due to 
the fibroid tendency in most chronic lung cases, so that an irri- 
tative or inflammatory disease can be made to heal more readily 
by putting the part to rest; and this quiescence is undoubtedly 
produced bv the gas injected and intended to remain in the ad- 
joining pleural cavity. It remains to be determined by exper- 
ience, however, if the undesired action of the affected lung can 
not be as well checked by the outward use of these traction 
plasters, while the undesirable and uncertain features of a com- 
plicated surgical procedure are avoided.