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produce the desired results, it should be the method of choice.
On the other hand, however, in selected chronic bacilliferous cases
of the moderately active type, surgical intervention has proved
to be a labour-saving device.
Collapse Therapy:
Artificiai Pneumothorax.
Of those cases which fail to respond to bed rest and the
Sanatorium regime alone, collapse of the diseased lung by artificial
pneumothorax is invariably tried. Some 20% of our cases
are subjected to this treatment. If the contra-lateral lung is
diseased, a course of gold salt therapy is given simultaneously.
Many remarkable results have been obtained in this way and our
artificial pneumothorax follow-up service from the Sanatorium to
the Chest Clinic is an established feature of the tuberculosis service
in the Borough.
Contra-Selective Artificial Pneumothorax.
Cauterisation of Adhesions.
In our experience an artificial pneumothorax, for it to be
effective, must achieve the result for which it was induced,
namely, such effective relaxation of the lung as to be responsible
for (a) As positive sputum becoming negative; (b) effective
closure of any existing cavities. Not infrequently the existence
of multiple adhesions prevents these desirable objects from being
achieved. If the adhesions are not too numerous, they may be
cauterised with excellent results. Many of our cases have responded
in this way.
Extra-Pleural Pneumothorax.
In selected cases the operation of extra-pleural pneumothorax
will be able to deal satisfactorily with multiple adhesions. During
the year about six of our cases of contra-selective artificial
pneumothorax with non-cauterisable adhesions have been treated
in this way. In two cases very good results were achieved. In
two cases a massive hydropneumothorax resulted; the fluid
gradually absorbed and inactive fibrothorax resulted. Of the remaining
two cases, irregular attendances, inability to follow out
instructions, and social and economic factors, were responsible