A Plea for Increased Caution in the Use of Surgical Collapse Therapy for Pulmonary Tuberculosis

Surgical collapse of the diseased lung is an important adjunct to rest and supportive therapy in the treatment of tuberculosis. The excellent results obtained in many cases by means of surgical collapse have, however, led many persons to prescribe its use too freely, or, having successfully collapsed a lung, to fail to continue a regimen of rest and supportive therapy. The success of some methods of collapse (f.i. artificial pneumothorax, thoracoplasty) has perhaps led to excessive use of less desirable methods such as extrapleural pneumothorax.

Whenever surgery is considered in a case of tuberculosis, the following questions must be answered. First, in what way will the patient be benefited by this operation? Second, do the hazards and complications, both immediate and remote, of the operation present a lesser danger than a decision to defer or abandon the operation? It is readily apparent that no blanket answers to these questions are possible. Each case must be decided on its individual merits. In tuberculosis as in other diseases the potential dangers of any operation must be weighed against the expected benefits. Above all, operations should never be done simply because they are possible, or in an effort to "do something". A haphazard approach will subject the patient to consequences which he can survive only with the greatest good luck.