Chapter 186: Artificial Pneumothorax

Having ideas is a good thing, but how much confidence you have doesn't depend on the doctor himself, but on another group of people who've suffered massive hair loss recently.

After reporting his two-week progress and reviewing the patient's condition to the Duke, Kraft snatched a piece of bread from his lunch tray and hurried straight to the workshop to inspect the craftsmen's work.

The jeweler, looking unwell, showed him something unexpected.

"How was this done?" Kraft carefully pinched the slender silver tube between his fingers, holding it up to the light.

The beam of light passing through its center confirmed it was indeed a hollow tube—thin, evenly walled, sharply pointed, and polished smooth. Minor hammer marks suggested it had been fashioned from a hammered silver sheet.

He had thought he'd never see anything so refined in his lifetime—having narrowly escaped the dreadful fate of using feather or bone needles. Though too narrow for intravenous injection, by thoracentesis standards, it was barely acceptable.

His only concern was material strength: bending was manageable, but breaking would be a true disaster.

The needle tip was fixed to a wooden plug, matching the leather tube he had requested. They fashioned the tube from rolled, thin leather, treated the overlapping edges with some adhesive—it was tougher than rubber, less flexible, but reliably airtight.

"Will this glue melt?"

"You could even blow bubbles underwater with it."

The craftsman's assurance eased Kraft's mind—he couldn't imagine the horror of the tube coming apart mid-procedure.

The air storage device was simplified to a large leather sac; after all, the pleural cavity held only a few liters, so there was no need to build a complex pump that might not seal properly. Still, it demanded considerable skill from the operator.

These items met Kraft's minimum operational requirements, allowing controlled artificial pneumothorax.

The procedure itself wasn't complicated—it was essentially the reverse of thoracentesis.

He needed to pierce the Duke's chest wall with the needle attached to the tube, penetrate the pleura clinging to the ribcage, and reach the space between the two pleural layers. Then he would inject air to collapse the lung via pressure.

This wouldn't happen in one go—it required multiple injections, meaning the patient would endure multiple punctures. Without anesthesia, the experience was hardly pleasant, but since the Duke had endured enemas and bloodletting, some trust in his tolerance was reasonable.

Looking back now, the original plan aligned well with current needs: under increased pressure, the lung would gradually compress, and the cavities within would shrink and close, leaving less and less comfortable space for the fungal spores until they abandoned this deteriorating habitat.

Theoretically, that was correct.

But this raised another question: how would it move?

In the ideal scenario, the fungus would manipulate its main mycelial mass, moving from the tubercular cavity into the bronchi, then the main bronchus, ascending through the trachea. It would crawl the longest stretch there—a period unlikely to be brief.

The airway must remain open, not blocked by expanding mycelial clumps. Fortunately, there was already something on hand that could serve.

"The tubing is well made. Make another one, but insert several metal rings inside to stiffen it—firm, but not too rigid." Toughness had its uses—perfect for a tracheal tube.

"Huh?"

……

……

"Your Grace, before we begin, I must inform you of the purpose and risks of this procedure."

"As previously stated, this is a therapeutic measure intended to temporarily relieve your pulmonary symptoms. It will not cure the disease, nor will it necessarily make you feel better." Kraft slowly unrolled the instrument pack, wiping everything with high-proof alcohol.

The craftsmen's assurances didn't include sterilization by boiling—final cleaning still relied on manual wiping, with reduced efficacy. The room filled with the sharp, pungent scent of alcohol.

The Duke closed his eyes and nodded, his expression far more relaxed than the doctor's—as if he were an unrelated bystander. "This smell reminds me of my youth. After I got lung disease, I had to give it up."

No, that was unlikely—he probably wouldn't have lived long enough to get lung disease drinking such liquor, Kraft thought to himself.

"During the procedure, there is a risk of uncontrollable events: prolonged issues like fluid leakage, persistent fever, worsening chest pain, or breathing difficulty; short-term complications may include subcutaneous emphysema, and in severe cases, vascular injury leading to embolism and life-threatening conditions."

The actual probability was low—both puncture and air injection would be guided by spiritual perception—but the formal notification had to be completed.

Upon hearing the final risk, the old Duke slightly lifted his eyelids. "May I ask—have any patients been frightened off by this list?"

"This is not fabricated—it is a real and present danger."

"If you ever have the misfortune—or fortune—of going to war, remember never to speak to your soldiers like this." As instructed, he lay on his left side, lifted his robe, and exposed his right chest for treatment. "Duke of Westminster consents to this procedure. Begin, Doctor Kraft."

"Thank you for your trust."

His fingers traced downward from above, counting to the eighth intercostal space, then extended laterally to the axilla, selecting the upper edge of the rib as the puncture point, avoiding the neurovascular bundle running along the lower rib margin.

A cold object pressed against his skin.

"Relax a little—this is just skin cleaning." A cotton ball soaked in alcohol circled outward from the puncture site, leaving a large, cooling circle on his back.

"Now, please endure a moment and minimize movement." Kraft laid a sterile drape, retrieved the needle connected to the tube—the tube sealed shut by a small clamp—"I recommend your guards hold you down; otherwise, unintended injury may occur."

Naturally, this suggestion was ignored.

Confirming all preparations were complete, he linked his spiritual perception, stabilized the skin at the puncture site, pressed the needle tip against the skin for several seconds to ensure the patient was mentally prepared, then began insertion.

Standing behind, he couldn't see the Duke's face, but he clearly felt the body shift from relaxed to rigid—the muscles tensed, rose, and breathing halted.

Aside from the faint clicking of clenched teeth, the only sound he heard was the heartbeat.

Spiritually, he "saw" the metal pierce through subcutaneous tissue, gliding easily through the thin fat layer, piercing the taut muscle, encountering slight resistance, then breaking through the chest wall and intercostal muscles, cautiously passing through the thin membrane adhering to the ribcage.

A hollow sensation returned to his fingers—confirmation: he had successfully entered the pleural cavity. The needle tip now rested just before the lung, less than three finger-widths from the fungal cavity.

The fungal mass clung to the necrotic, hyperplastic tissue and granulation-woven walls of the cavity, as still as a field mouse hibernating in its nest, utterly unaware of what was happening.

Kraft connected the tube to the air sac, slowly released the clamp, allowing gas to flow into the pleural cavity as evenly and slowly as possible. "You may resume breathing, Your Grace."

As the Duke's breathing rhythm continued, a small amount of air mixed into the process—the lung's expansion began to be restricted.

The effect was still subtle; if a frontal chest X-ray were taken now, it might show only a narrow, faint outer dark band, barely distinguishable from the lung field, with fine pulmonary textures ending at a translucent boundary before the dark zone.

After each small injection, Kraft paused for two breaths to assess compression and fungal status.

Perhaps due to habituation to the lung's natural pressure fluctuations, the fungus showed far less sensitivity to pressure changes than to other stimuli. Even as the injected volume neared half the Duke's resting tidal volume, it still showed no aggressive reaction.

Compression was already evident: elastic lung tissue expanded differently than scarred, diseased tissue during inhalation, producing initial compression of the cavity. The fungal mass's Rongmao -like filaments stirred faintly, as if awakening to the shrinking space.

Kraft promptly halted the gas injection, withdrew the needle, and applied a cotton dressing to the puncture site, ending the first phase.

"Your Grace, please rest flat for a while. I don't want to see you display extraordinary courage again until after your next proper meal."