The Treatment of Pulmonary Tuberculosis by Collapse Methods

To attain the collapse of a diseased lung, wholly or partially, temporarily or permanently, is now an accepted aim in the treatment of pulmonary tuberculosis. The object of the treatment is twofold. By collapsing the lung, healing is promoted by rest and the circulatory changes which collapse entails. The release of toxins and possibly also of living tubercle bacilli into the blood and lymph-streams is also checked, and the signs of toxaemia diminish. Two procedures widely different in their nature and scope have been already in common use since the beginning of the present century: artificial pneumothorax and thoracoplasty. More recently other methods have been used with success, both as supplementary aids to pneumothorax and thoracoplasty, and also as alternative methods of bringing about and maintaining collapse of the lung. The most important of these is the operation of phrenic evulsion, which was introduced by Felix in 1921 as a substitute for phrenicotomy. Oleothorax and gelatinothorax have also come into prominence only within the last few years, although the former method, oleothorax, was recommended by Hippocrates for the treatment of empyema. The cauterisation of adhesions complicating pneumo-thorax and preventing an efficient collapse of the lung is another valuable addition to collapse therapy. This method was first demonstrated by Jacobaeus in 1913, and is now employed widely. In 1922 Maurer devised an improved technique for dividing pleural adhesions, which has diminished the dangers of the operation and greatly enlarged its scope. Several other operations have been tried in connection with collapse therapy, such as extra-pleural pneumolysis, division of pleural adhesions by tenotomy or by open incision through the chest-wall, and multiple intercostal neurectomy. These latter methods have not come into general use, either on account of their dangers and limitations, or because they have been superseded by surer and safer means. It is too soon to dogmatise about the possibilities or the limitations of those methods which are of definite value, except thoracoplasty, which has well-defined indications and limitations. Artificial pneumothorax is used today on a scale undreamt of in 1914, and there is a marked tendency to resort to this method of treatment at an early stage of the disease. A protean disease-and pulmonary tuberculosis is the very type of such a disease-requires diverse methods of treatment, according to its severity and stage of evolution. It appears that some cases will recover without any special treatment, that a group of …