Artificial pneumothorax in the treatment of pulmonary tuberculosis.

In view of the increasing advances in our knowledge of pulmonary tuberculosis it is indeed timely that we should, while none the less maintaining a progressive outlook, 'go wisely and slow-they stumble that run faster.' In other words, we should now pause to assess the situation in so far as the position of artificial pneumothorax in the sphere of collapse therapy is concerned, and ask ourselves whether, in the light of increasing experience, the early enthusiasm for this particular measure in the management of pulmonary tuberculosis from the active stage to complete quiescence, has been justified. At the outset we must recognize that, no matter what form of treatment is contemplated, the general constitutional nature of the disease must never be' forgotten, nor the possible influence in an individual of an inherited diathesis affecting the local lesion. Special measures must be regarded primarily as adjuncts to the basic method of treatment by bed rest and the sanatorium regime, for which indeed there is no real substitute. Artificial pneumothorax as we know it today, discriminately used with adequate radiological control, has certainly revolutionized the management of certain cases of pulmonary tuberculosis, particularly in regard to mechanical factors confined to the local lung lesion. While recognizing this I intend, for purposes of this discussion, to be somewhat provocative and to speak of the limitations, difficulties and disappointments in relation to pneumothorax therapy often encountered in clinical practice. More than 20 years ago when I first plunged into the maelstr6m of this disease I felt that the subject, whilst complicated, was not incapable of solution. Today as a result of evergrowing knowledge and experience of the combined resources of collapse and other forms of