Others have shown the advantages of selective collapse of the lung, and in this article its importance has been emphasised, an importance that is frequently not appreciated by those who use artificial pneumothorax, particularly by those who are responsible for the early stages but are not in contact with the late results. It is easy to be satisfied with the immediate control of symptoms, and to blame those responsible for the after-care when the partial pneumothorax obliterates or a relapse occurs. By not making use of all the means at our disposal the fullest benefit from peneumothorax cannot be expected. Once it has been decided that pneumothorax is the best treatment for a case, then selective collapse and relaxation of the diseased area of the lung should be aimed at, and this should remain the aim in every case until it has been proved unattainable. Since adhesions may cause trouble when the artificial pneumothorax is abandoned, they should be divided, even if doing no obvious harm either radiologically or symptomatically, unless the division is so difficult as to become dangerous. When symptoms of incomplete collapse are present, the division of adhesions becomes essential as being the only alternative to the abandonment of the artificial pneumothorax and the undertaking of other and more drastic forms of collapse therapy.
It has been shown that it is possible to attain selective collapse in a reasonable proportion of cases, and that this can be done with a minimum of danger and discomfort to the patient, and with no greater incidence of pleural effusion and empyema than that expected to occur in pneumothorax cases.
The general outline of the operative technique has been described, but it is felt that it is unnecessary to give a fuller description, as it is a technique that can be learned only by experience, and should not be embarked upon without study at a clinic where both this and other thoracic surgery is carried out.
The conclusion is that the division of adhesions is an operation that should be readily available in every sanatorium where artificial pneumothorax is used as a therapeutic measure, and that a thoracoscopy should be performed in every case of partial pneumothorax. Such is the value of complete or selective collapse that every adhesion should be divided, providing it can be done with reasonable safety. When assessing “reasonable safety” one must take into consideration the degree of benefit that the particular patient will derive from the division of his adhesions.
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