Indications for collapse therapy.

The indications for collapse therapy in the treatment of tuberculosis, simply stated, are—an active pulmonary lesion. Collapse therapy has come to the front as the most effective treatment of pulmonary tuberculosis and ahead of the older measures of rest, fresh air, diet, and climatic change. There is little difference of opinion about the effectiveness of collapse therapy as determined by clinical observation, but a satisfactory explanation of the "why's and wherefore's" of these benefits is not easy. The theory that the added rest is the important factor has little to appeal to me. Cavity closure is unquestionably important. Changes in circulation and lymphatic drainage in the collapsed lung may have something to do with the benefit. However, the theory as first propounded by the late Dr. Breidenbach, of Dayton, and stressed by the late Paul Coryllos, of New York, that a relatively anaerobic condition is present in the collapsed lung which is unfavorable to the development of the tubercle bacillus, which is an aerobe, is the theory that most reasonably explains the benefit of collapse treatment, in my opinion. It is a mistake to believe that collapse treatment alone can bring about the arrest of pulmonary tuberculosis. A patient must have some resistance as evidenced by his ability to form fibrous tissue to encapsulate the tubercles and lay down calcium. In spite of adequate collapse the disease will be progressive in certain cases with spread of the disease to various parts of the body. We have no explanation for this factor of resistance, but it can be estimated to some degree by consideration of the clinical manifestations and the study of the character of the pulmonary lesion on the x-ray film. The patient with poor resistance often runs a high temperature, shows a progressive weight loss, develops early evidences of extrapulmonary complications. The pulmonary lesion is often extensive and progressive, and has a soft diffuse appearance on the x-ray film. The patient with a relatively good resistance often exhibits few evidences of toxemia, shows some tendency to improve under ordinary sanitarium regime, and x-ray studies reveal the lesions to be more discrete, with some retrogression and tendency towards fibrosis and calcification. While use of collapse is