Recent advances in the surgery of the lung and pleura

THE surgery of .;arious parts of the body ha.; always bccn subject to fitful periods of stagnation alternating with periods of progress, set going usually by some new discovery as to the naturc of a discasc or by smic dcvclopnient 111 general technique. For the intrathoracic region the inactlve period has been a very long o w , and it is only within thc last decade that thc chanFe has come. Yct so markcd is this change, so rapid the progress which is being made, that nlthongh previously, few conditions otlier than some of tlie acute inflitmmntory ones were dcalt with by surgical measures, at the present timc there is scarcely an intratlioracic lesion, from bronchitis and emphysema to carcinoma of thc lung, wliich does not yield a steadily Increasing proportion of satisfactory and encouraging results to the new mcthocls of active trcatment. Many who have not followed closcly modern advances i n the surgery of the lungs, have erroncously conceivccl tlic idea that the progress has been exclusively in the technique allowing of operations in the open chest. The realization by Sauerbruch and Erauer of their cndcavour to discover the means of ovwcoming the dangers of operating with an uncompensated pneumothoras has uncloubtedly greatly facilitated the surgical treatment of certain groups of intrathoracic diseases. The total number of cascs. liowevcr, in which this technique is rieccssary is quite small comparccl with the great number of paticnts who haw benefited by moclcrn progress. l h c rcsult of such progress has been the cmcrgciice o€ three main lines of treatniciit, wliich may bc termccl : ( I ) Trentinent by collapse , (.) Treatment by consolidation and fibrosis (solidific3tion) ; (3) Trc:ttment by excision. Treatment by collapse is the most striking advance in pulmonnry surgery in that it is applicable to many pathological conditions and is an cntircly original procedure applicable to no othcr part of the body. ,.