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Such cases require very careful selection, and should only be
dealt with by an expert Thoracic Surgeon.
In this connection we have had the valuable help of the
Surgeons to the Brompton Hospital, who have performed plastic
operations on the chest on three patients, in order to collapse by
surgical means (" phrenic evulsion " and " thoracoplasty ") cases
which were unsuitable for an artificial pneumothorax.
The Use of Insulin in the Treatment of Pulmonary Tuberculosis.
A note should just be made on the use of Insulin in certain
very selected cases of pulmonary tuberculosis without active
disease, but with a marked disturbance of nutrition.
In a few cases careful graduated doses of Insulin with the
compensatory use of glucose has created such a marked improvement
in appetite as to produce a pronounced increase in weight
and resistance in the patient, with a corresponding improvement
in the general condition.
Importance of the Psychological Factor in the Treatment of
Tuberculosis.
This very important factor must never be lost sight of in this
field of work.
Mental hygiene and its relation to :
(a) Physical improvement.
(b) Mental placidity.
(c) Increase of ability to become self-supporting is now
fully appreciated.
Tuberculosis is a disease peculiarly fitted through its long
duration, disturbance of social relations, financial burden and
segregation, to foster emotional stress, which in itself may be a
precursor of tuberculosis.
The importance therefore of mental re-education to instruct
the patient in the mode of dealing with his emotional problems
and tracing them to their source has to be encouragcd.
A spirit of optimism, faith, courage and fortitude are
undoubted factors of therapeutic importance, and such a spirit is
encouraged wherever possible.