Closed intrapleural pneumonolysis.

In 1882, Forlanini12 of Milan proposed the induction of artificial pneumothorax in patients suffering from pulmonary tuberculosis, and in 1894’s he published his experience with the first patients to be submitted to this form of therapy. In 1885 Cayley had reported the case of a tuberculous patient in whom he had induced pneuniothorax by open incision of the chest wall to control hemoptysis, and in 1888 Potain, who used a manometer to measure the Intrapleural pressure, published work on air replacement in tuberculous patients who had suffered spontaneous hydro-pneumothorax. Forlanini, however, was the first to induce pneumothorax with the objective of controlling the tuberculous process in the diseased lung itself. Following Forlanini, the next significant advance in artificial pneumothorax therapy was due to J. B. Murphy of Chicago, who in 1898 urged the use of radiology to control the degree of collapse. With the routine use of the manometer by Saugman in 1904, the technique of artificial pneumothorax was placed on a sound basis, and by about 1910 this procedure had begun to take its place as an established form of therapy In pulmonary tuberculosis. Early in the history of artificial pneumothorax the significance of pleural adhesions in preventing effective collapse was recognized, and in 1894 Forlanini’3 wrote that “the pleural adhesions limit the volume of the pneumothorax and therefore Its curative value.” Matson,19 from an experience of 1,500 patients suffering from pulmonary tuberculosis treated by artificial pneumothorax, found that 40 per cent of failures were due to pleuritic adhesions which prevented satisfactory collapse. Alexander2 states that diffuse adhesions prevent induction in about 20 per cent of attempts at artificial pneumothorax, and that in approximately 42 per cent to 50 per cent of cases adhesions allow only partial pneumothorax, insufficient to bring about complete healing of the lesion. It was inevitable, then, that attempts to devise methods of freeing adhesions should be made, and in 1908 Freidrich of Marburg divided adhesions through an incision made Into the pleural cavity; this operation, known as open Intrapleural pneumonolysis, continued to be practised for a number of years, but owing to the