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Streptomycin, P.A.S. and Isoniazid continue to be the drugs of
initial choice for treatment but there are now several other very
effective anti-tuberculous drugs which are used in complicated cases.
The tendency now is to give anti-tuberculous chemotherapy for
longer and longer periods. No patient has this treatment for less
than about a year, and it is continued in many cases for several
months after the patient has returned to work. In some cases,
particularly those with extensive disease, this treatment has been
carried on for two or three years and the results of this have been
dramatic. There follows a special note on this treatment in chronic
sputum positive cases later in this report.
Artificial pneumothorax has now been almost completely
superseded by other methods of treatment. Pneumoperitoneum in
conjunction with chemotherapy is still a very effective form of treatment
in many cases and produces excellent results.
Major thoracic surgery has played a large part in treatment of
pulmonary tuberculosis but the number of patients who need major
surgery is diminishing. In 1954, 39 patients had major chest surgery
but in 1955 only 29 were operated on as follows—
Men Women
Thoracoplasty 3 0
Lobectomy 9 9
Segmental Resection 3 1
Pneumonectomy 0 1
Decortication 1 0
Bilateral Plombage 0 1
Lobectomy and corrective thoracoplasty 0 1
The average age of the men was 30 years with extremes ranging
from 15 years to 59 years and in the women the average age was 31
years with extremes from 22 years to 55 years. There was one postoperative
death, a woman aged 29 years with extensive Tuberculosis
who died 8 weeks after the operation.
There are now under the Chest Physicians' care 184 patients who
have had major thoracic surgery for tuberculosis. Of these, four
still have active disease and are unable to work and two, although
their tuberculosis has been controlled have suffered so much lung
damage that they are respiratory cripples and able to lead only very
restricted lives. The remaining 178 patients are well and leading
normal lives. Their operations were—