DISEASES OF THE CHEST Indications for Collapse Therapy

THERE is no form of treatment for pulmonary tuberculosis in which such rapid progress has occurred in recent years as collapse therapy. While it came into general use in this country in the form of artificial pneumothorax about 1912, it was only used in the exceptional case for some years. During the writer's experience its use has extended from a small percent of cases with ideal indications to the point where it is at least considered in every patient whose disease has passed through the early stages. My purpose in this paper is to bring out a few points on the indications for the various forms of pulmonary collapse used in phthisic-therapy, mainly because I believe there is a growing tendency to carry this treatment to the other extreme. This is often the case when a method of treatment meets with success and it would seem wise to strike a happy medium between extreme conservatism and the more radical measures which are beginning to be employed. Of all forms of collapse therapy, artificial pneumothorax remains the best procedure, if it can be used, as it is the simplest and safest and affords the most satisfactory collapse of the diseased area. It has the additional advantage that it can be abandoned should active disease occur in the contralateral lung. The ideal indications are extensive disease in one lung with little or no disease in the other. The tendency in the past has been to delay compression until the patient was given a chance to improve without it; however, in so doing valuable time has frequently been lost as during the delay adhesions have formed which prevented either the induction of the pneumothorax or sufficient collapse to be effective. While we are aware of the fact that extensive pulmonary disease with cavitation may heal without collapse, the chances are so much better with it, that pneumothorax had better be induced at the start in this type of