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this, the diaphragm is paralysed by destroying its motor nerve
supply—the Phrenic Nerve. The operation, which is quite
simple and causes very little upset to the patient, consists of
exposing the nerve in the neck and removing it, or simply crushing
it and can be done in a few minutes under a local anaesthetic.
Thoracoplasty is a more radical method of inducing collapse of
the lung. Here again the collapse is induccd by reducing the
capacity of the thoracic cavity. A part or the whole of several
ribs is removed and the chest wall allowed to fall in on the subjacent
lung, thereby permitting the latter to contract and close
any cavity. As previously mentioned, the operation should only
be done when other methods have failed, and then only after
careful consideration of the individual case by experts. The results
of this operation are encouraging, and with improvement in
technique and by completing the operation in several stages,
the risks have been considerably reduced.
Apicolysis (as its name implies) aims at securing a collapse of
the apex of the lung. Its usefulness is accordingly limited, as it
can only be applied to those cases with disease confined to the
apex of one lung. The adherent lung is separated from the
adjacent rigid chest wall, and the space thus made filled with
some firm substance such as paraffin wax. The operation does
not inconvenience the patient unduly, and does not usually produce
much surgical shock. It has, therefore, comparatively little risk.
The foregoing operations, with the exception of the refill in
Artificial Pneumothorax cases, are carried out on patients while
warded in Hospitals, by Surgeons specially qualified to do work
of this nature. On the other hand, patients for refills attend
as ordinary out-patients. Hitherto all refill cases have attended
a special clinic of the Hospital conducted by two members of the
Hospital staff. Consideration is now, however, being given to
a scheme whereby refills in Dispensary cases will be given by
the Tuberculosis Officers. This arrangement will necessarily
entail a considerable increase in our work, and may necessitate
some rearrangement of the sessions, but it will be advantageous
in that patients will be under the control of one doctor.
One hundred and seventy-eight cases were admitted to Hospital
or Sanatorium through the London County Council during the
year. With increased accommodation at their disposal the
Council has been able to reduce the waiting period considerably
in recent years, and now offers sanatorium treatment to all
patients with prospect of cure, or such reasonable expectation
of improvement in health as will enable them to resume work.
In spite of sporadic attempts to belittle the good results of
sanatorium treatment I am convinced they are uniformly satisfactory,
and without minimising the importance of other
methods, it still remains in the majority of cases our sheet-anchor