A Present View of Collapse Therapy in Pulmonary Tuberculosis *

Collapse therapy, as a term, embraces a variety of procedures and has developed rapidly in recent years. The literally enormous number of publications upon the subject testifies to the interest in it. The naturally radical see in it the greatest therapeutic advance of the century, while even the most conservative concede it a great step in advance. No one dealing with pulmonary tuberculosis can ignore it. Controversy still reigns on some points; is silenced on others. How the various forms of collapse therapy work their effect physiologically, whether through an influence on the pulmonary lymphatics or circulation, is not settled. On the mechanical side, however, there is considerable agreement. The diseased lung is subject to tension and trauma owing to its enforced apposition to the moving chest wall. Cavities are held open, fibrous scar tissue cannot contract beyond a limited degree. Both stretch and contract with respiration. Collapse procedures change the condition from tension to relaxation, permit the retraction of scar tissue and the closure of cavities, lessen respiratory trauma, and thereby greatly aid nature in the healing process. None of these surgical measures heals in itself, although with their help nature can and does heal more quickly and more effectively. A patient may, with a successful pneumothorax, lose his symptoms, close a cavity, and be outwardly well in a few weeks, but the healing process is only begun. The fundamental point must be stressed that all collapse or compression methods are merely adjuvants to the old, time-tried therapy of rest. They are designed to increase the lung rest and render it more effective. They do not replace other forms of lung rest. Speaking in a very general way, one may say that pulmonary tuberculosis assumes two forms: the exudative form in which the pathology is more pneumonic in character, and the productive form