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Pneumoperitoneum.—In contrast to artificial pneumo-thorax
whereby air is introduced into the pleural cavity, in pneumoperitoneum
the air is introduced below the diaphragm.
The problem of decreasing the volume of the thoracic cage is here
approached from below rather than from above the diaphragm. The
idea of raising the diaphragm by injecting air into the peritoneal
cavity has recently attracted much attention among tuberculosis
workers. Its great value lies in its ability to enhance the rise of the
diaphragm following phrenic nerve intervention. It may assist in
closing certain types of apical and basal cavities and possibly in
promoting healing. Cases for this treatment require careful selection
and as with pneumothorax, pneumoperitoneum refills are given with
careful X-ray control. The method has the advantage over pneumothorax
therapy in that it is less open to complications. The potential
risk of pleural infection and the formation of adhesions is ever present.
Resection of Lung.—(Lobectomy, Pneumonectomy). This
method of treating certain cases of cavities which are resistant to
collapse therapy is still on trial. Certainly tension cavities failing to
respond to other forms of treatment and tuberculomas of the lung
should be eminently suitable for this type of treatment. One of our
cases of tuberculoma of the lung who had a lobectomy has made
an excellent recovery and attends the Clinic at regular intervals.
Theoretically, this method of resection of pulmonary tissue would
appear to be ideal, for the diseased lung is removed, there is no
possibility of a breakdown of the old lesion, and the patient is not
d isfigured.
From our fairly wide experience of the removal of a lung for
cancerous invasion, we know that the absence of one lung is compatible
with good health, and enables the patient to return to his work.
Plea for Conservatism in Relation to Collapse Therapy.—
Despite all these methods of surgical approach to the lung that have
been reviewed, our experience reaffirms the need for increased caution
in relation to their use based upon judgment, a balanced outlook
and experience. In certain cases there may be overwhelming reasons
for ''masterly inactivity'' despite the mere dramatic appeal that
surgical intervention may make. The sanatorium regime, observance
of its principles, both in and out of the sanatorium, mental and
physical rest and supporting treatment are still the essential and basic
principles.
The excellent results obtained in certain selected cases where
surgical collapse therapy has been utilised does not justify its