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125
Moreover, the high reputation of the Hospital in the district gives
a greater prestige to the Dispensary than it would be possible for
it to secure under other circumstances.
The number of cases referred for X-ray examination shows a
very marked increase. As pointed out in last year's report this
increase is only to be expected, as the use of X-rays is now not
limited to diagnosis, but is also helpful in showing us the extent
and progress of the disease—information of the greatest value in
deciding appropriate treatment. They serve as a guide in the
choice of suitable cases for surgical treatment, and during the
progress of treatment of Artificial Pneumothorrax they are indispensable.
With the great advance in radiological technique during the
last few years we have been able to gain much more accurate
information of the exact pathological processes occurring in a
patient's chest. In a series of X-ray films healing processes in
the lungs can be closely followed, or if there is no response to
treatment, a gradual destruction of tissue is noted.
It is this destruction of lung tissue that gives rise to " cavities,"
the great bugbear of successful treatment, and it can never be
assumed that the disease is arrested so long as they exist.
Occasionally, it is true, a cavity may close by ordinary medical
treatment, but more frequently the natural processes of healing
require some assistance in closing them. The best means known
to us at present is to collapse the lung, and it is with this object
that all modern surgical methods have been devised.
In view of the importance surgery has attained in the treatment
of Pulmonary Tuberculosis and the increasing numbers of our
cases undergoing this form of treatment, it might be advisable
briefly to describe these methods.
Those in common use are four in number ; Artificial Pneumothorax,
Phrenic Avulsion, Apicolysis and Thoracoplasty. The
three last are used where Artificial Pneumothorax offers no
hope of success, or has failed owing to the lung being adherent
to the chest wall.
Artificial Pneumothorax consists in inducing collapse of the
lung by the injection of air through a hollow needle between the
chest wall and the lung. The air, in a varying space of time,
becomes absorbed and has to be replaced, this replacement being
known as a " refill." The injection is practically painless and
gives rise to no discomfort, so that patients are capable of carrying
on their work during the course of treatment.
The operation of Phrenic Avulsion is performed when Artificial
Pneumothorax has failed, or has been only partially successful in
collapsing the lung owing to the presence of adhesions between
the lung and the chest wall. The collapse of the lung is attained
in this case by reducing the capacity of the thoracic cavity. To do