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phrenic evulsion, thoracoplasty, and others, the discussion of which
would be too technical for inclusion in a report of this nature.
The London County Council have surgical units for chest cases
in certain of their general hospitals, and at all their large sanatoria
consultants in this branch are available. Artificial pneumothorax
is taking an increasingly prominent place, and I therefore wish
to make some reference to it. It is a comparatively simple
operation, carried out by the physician rather than the surgeon,
and consists in the introduction of air into the pleural space, i.e.,
that space lying between the inner aspect of the chest wall and
the outer surface of the lungs. By this means the diseased lung
is collapsed and allowed to rest, the whole of the respiratory
process devolving on the opposite and healthy lung. Once the
lung has been collapsed it is necessary to give refills of air that
vary with the special needs of each case, and in the spacing of
which considerable experience and judgment are required on the
part of the operator. As the collapse has generally to be maintained
on an average for a period of about three years, it is obvious that
this must be done for the most part in an out-patient department,
since few people remain in an institution for longer than a year.
The financial responsibility for continuance of Pneumothorax
treatment falls on the Borough Councils and not on the L.C.C.
once the patient has left hospital or sanatorium, and special clinics
are maintained at the chest hospitals such as Victoria Park and
Brompton, to which payment is made for this service. It may
be said as a general rule that the success of Artificial Pneumothorax
depends on the selection of the right case, those with comparatively
localised trouble in one lung, which has not responded to the usual
regime, affording examples of the maximum benefit to be derived
from it. At the present time it can hardly be said to be justifiable
to use it in every early case, while unfortunately in the majority
of persons seen for the first time, the disease has progressed too
far for it to be applied with reasonable hope of success, though
there are necessarily intermediate cases in which it is felt right
to give it a trial though the outlook is less promising. The m< re
fact that we have at our disposal a method of treatment with
which we can intervene for the patient's benefit at any time when
his disease is not too far advanced to render it useless, only
emphasises the need for early diagnosis in order that more and
more patients may be brought within the Tuberculosis Scheme
while still in a curable condition. On the other hand, it must
be realised that Artificial Pneumothorax is by no means universally
applicable, and there will be numerous cases in the future, as
there have been in the past, who will recover without it.
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