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for unsatisfactory results. In my experience, in view of the close
supervision required; the necessity for frequent refills with big
pressures, and serial radiological control, these cases, after operation,
should remain in Sanatorium for some months if satisfactory
results are to be obtained. Early experience of the application
of extra-pleural pneumothorax leads us to the view that its
application is a limited one, and careful institutional control is
essential for good results.
Thoracoplasty.
An effective partial or complete thoracoplasty in selected
unilateral fibrocaseous disease with cavitation—for which BED
REST or ARTIFICIAL PNEUMOTHORAX has no place—is
undoubtedly the operation of choice. In association with an
adequate period of post-Sanatorium treatment, the operation
often proves a life-saving device. It is now our routine procedure
—in collaboration with the thoracic surgeon—to inform the
patient that the operation necessitates an adequate period of
Sanatorium treatment subsequently. If the patient refuses this,
he is informed that the operation is worthless. With such preliminary
explanation, no real difficulty in obtaining the patient's
co-operation has arisen. In consequence most of our results have
been excellent: the collapse has been effective, cavities have been
closed, a positive sputum has been rendered negative and the
general health of the patient has vastly improved. Regular
supervision and follow-up of these cases at the Clinic has maintained
these results in the bulk of our cases. The mechanism of
the closure of cavities is a complex problem which cannot here
be discussed and it is only fair to point out here that in a very
limited number of cases a cavity, even with what appears to be
a perfect artificial pneumothorax or thoracoplasty, may not
close.
List of Cases subjected to thoracic surgery during the year.
Twenty-five cases were submitted in all, as follows:—
Thoracoplasty, 6; Extrapleural pneumothorax, 6; Cauterisation
of Adhesions, 9; Bronchoscopy, 3; Lobectomy, 1.
X-ray Examination of the Chest.
So much of our modern knowledge of chest disease is attributable
to this important method of examination that, year by
year, increased use is being made, as an examination of the