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itself it must be recognised that it is not a specific cure for tuberculosis.
It is important, however, carefully to recognise its uses
and limitations if its value is not to fall into disrepute, and our
experience of it during the last ten years or so has enabled us to
assess its results. If complete collapse can be obtained the results
are obviously better than only a partial collapse. In some cases
a collapse of only the healthy lung is obtained, the diseased lung
remaining unaffected; in other words, there is a contra-selective
artificial pneumothorax which is useless and which we always
abandon. Results are also infinitely better if there is no contra
lateral disease, and hence the greatest care is needed in the
original choice of the case suitable for this type of treatment. It
is generally recognised that a suitably chosen case with an
effective pneumothorax has unquestionably an improved chance
of survival.
Wherever incomplete collapse is obtained auxiliary methods
by surgical means are always employed whenever possible in the
form of (a) Section of adhesions; (b) Phrenic operations; (c)
Plastic operations on the chestwall, to endeavour to obtain a
selective collapse of the diseased lung. As Bentley has so wisely
pointed out in his admirable survey on Artificial Pneumothorax,
the great majority of patients as we find them are not suitable
for the treatment, and also that pulmonary tuberculosis is sometimes
a disease curable by the adoption of simple methods calculated
at raising the general resistance of the individual. It is in
this critical manner that all our patients are reviewed before undergoing
treatment in this disease.
The Operation of Extra-pleural Pneumothorax, whereby the
lung tissue is carefully stripped from the pleura, seeks to secure
a selective collapse. Refills are then given at regulated intervals,
the needle being introduced just above the site of the wound,
whilst the patient is in the sitting posture.
We are now treating such a case with frequent small refills,
the terminal pressure being +20 +15, with very good results so
far.
Blocking of a bronchus by means of a balloon inserted through a
bronchoscope as a means of collapsing a large cavity.
The production of a selective collapse of the lung—i.e. a
collapse limited to the diseased area alone—is one which we strive