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to obtain but rarely achieve. It has the great advantage that the
healthy lung tissue is conserved unimpaired. An attempt has
recently been made to find a method which may secure a selective
collapse of the diseased lung in the course of an artificial pneumothorax.
It has been observed by American workers that when
massive collapse of the diseased lobe occurs by accident, as for
example sometimes happens when haemoptysis occurs, the tuberculous
disease then shows a lesser tendency to activity.
Attempts have been made to occlude completely the bronchus
of the diseased lobe for several hours, by insertion of a bronchoscope,
and a balloon which can be distended left in situ for some
hours. Massive selective collapse of the involved lobe can thus
be induced.
A patient under my care at the present time has a large
cavity which has failed to collapse with an artificial pneumothorax,
and the surgeon is attempting to obliterate the cavity by
completely occluding the bronchus of the corresponding lobe to
induce a massive and selective collapse by this method.
We are awaiting the results with the greatest interest, for
if successful it promises to avoid more drastic surgical operations
in the future.
Pleural Effusions.
So many cases of a clear pleural effusion of the type of an
exudate come to our notice which have not been notified, and
have subsequently developed tuberculous lung disease, that too
much emphasis cannot be made on the importance of recognising
the fact that every clear pleural exudate, especially in young
subjects, should be treated as pulmonary tuberculosis and undergo
a complete sanatorium regime. Were this to be generally recognised
the prognosis in these cases would be admirable and lung
tuberculosis in such cases a very rare occurrence.
Diagnostic Unit.
The facilities for diagnosis at the Clinic are sometimes
limited because of the necessity for observation, for certain selected
cases, in bed. It is here especially that our very close co-operation
with the Sanatorium is of the greatest value. Quite a series