Cavernostomy and tamponade of pulmonary cavities with para-aminosalicylic acid.

The pulmonary cavity is the focus considering the campaign against tuberculosis. The cavity decides the patients fate and dominates the epidemic state of tuberculosis. The persistence of the destructive lesions perpetuates the source of infection. Of people in whom sputum tubercle bacilli are found, more than 50 per cent die within 10 years of the discovery, in spite of collapse therapy and sanatorium care. This has been so up to the present, and the future will show how much antibiotics and chemo-therapeutics will be able to reduce this alarming mortality. Streptomycin is generally effective in hyperaemic foci such as specific meningitis, laryngitis, bronchitis and some forms of intestinal tuberculosis. On the other hand, foci whose blood supply is reduced by lical trombosis, such as a caseous lung infiltration or a cavity wall, are as a rule not affected by streptomycin or paraaminosalicylic acid. Ulcerations of the larynx or of the intestines may heal, whereas the lung cavity, which has provoked it, will remain and may cause further disseminations in the lung or elsewhere. A second, even a third course of treatment must then be undertaken which is likely to end with the development either of toxic symptoms in the patient or streptomycin resistance in the tubercle bacillus. Therefore the tuberculous cavity remains the deciding factor in the survival of the patient and the perpetuation of the epidemic state in spite of antibiotics and chemo-therapeutics. Taking into consideration the reduced permeability of the cavity wall and its poor blood supply, we introduce an adapted procedure. The three essential phases of the method are: 1) The gradual establishment of the cavernostomy by means of laminaria sticks, that is a “stoma” between the skin and the cavity. 2) The regular packing of the cavity with gauze, soaked in streptomycin or P.A.S. 3) The closure of the draining bronchus by means of diathermy, applied through an operating thoracoscope. The draining bronchi of the cavity are generally open. If they appear to be closed, it is our experience that in active and suppurative cases this closure is fictitious and not a true one in the