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71.
has naturally to be very carefully considered before being
initiated, for there are many factors which contraindicate
it. It is usually commenced whilst the patient
is in an institution and can have constant observation
and X-ray control: after the lung is fully collapsed the
treatment may be continued on return from the institution
by periodical refills of air which keep the lung in a
state of collapse. In Oleo-thorax the admission of
sterilised oil instead of air is carried out.
Such out-patient treatment may go on for months
and years if considered, advisable, the patient meanwhile
being able to resume a normal working existence.
Under arrangements made between the Fulham
Borough Council and certain of the London Hospitals
(chiefly the Brompton Hospital and University College
Hospital) such refill cases are dealt with at the latter
institutions after having been seen and approved by the
Tuberculosis Officer.
X-ray examinations are indispensable in carrying
out this form of treatment and its successful continuation.
Certain cases do not function well on account of
adhesive bands of tissue which prevent proper collapse;
and the presence and situation of these can only be
determined with accuracy by skiagrams.
(2) and (3) can be briefly described as operations for
causing collapse of lung tissue by surgical means, such
as the removal of ribs or the insertion of sterilized wax
or fat into the chest cavity.
(4) The phrenic nerve supplies nervous energy to the
diaphragm, which is the main organ of respiration, and
these operations (either for stretching or division of the
nerve) are designed to check respiratory movements on
the side affected.
(5) Tuberculin Injections. are carried out in certain
institutions and appear to have a beneficial influence on
certain cases. Experience however does not show evidence
of benefit in every case; and unless carefully
watched severe reactions are possible.