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Pleural Adhesions can frequently be dealt with by cutting
them, with the aid of a thorascope, with the Electrocautery, and
this procedure of thoracoscopy and cauterisation of adhesions—
in the hands of an Expert Thoracic Surgeon—may be responsible
for a complete lung collapse.
Phrenic Evulsion or Crush is another method of attack,
which has been described in previous reports.
Where artificial pneumothorax, with or without the aid of
adhesion cutting is impossible, the more permanent method of
surgical collapse of the lung is carefully considered. Here the
very closest co-operation between the patient, physician and
thoracic surgeon is essential for success. This team work is of
the greatest importance. Several of our patients have undergone
treatment by
Partial or complete Thoracoplasty with strikingly successful
results. In some cases the procedure has proved to be a lifesaving
device.
This recognition of lung immobilisation in the treatment of
pulmonary tuberculosis has, of necessity, meant additional
medical and nursing work entailed by this modern outlook.
Finally the question of Drug Therapy which has played no
little part in the more recent advances in treatment. There exists
no specific drug treatment for tuberculosis, and in consequence
many therapeutic agents have been, and continue to be, recommended
for its cure nevertheless, certain drugs have been proved
to be of value in clinical practice. All such known drugs are
being utilised in the treatment of our patients.
Cold Salts in conjunction with collapse therapy, or alone, are
being used with an appreciable degree of success. Healing of
tuberculous lesions, in selected cases, is not infrequently observed,
reduction of the expectoration of sputum is experienced, and
infective cases with tubercle bacilli in large numbers sometimes
respond to a full course of treatment by becoming non-infective
and losing their tubercle bacilli. The indiscriminate use of the
drug is, however, fraught with danger, and its indications and
contra-indications must be recognised.