Cavitation in the lung continues to
present a difficult problem in the clinical
treatment of tuberculosis. The greater part of
the clinical treatment of pulmonary tuberculosis is
directed towards endeavouring to close cavities.
This is partly due to the fact that no specific
remedy has been found until recently to combat the
tubercle bacillus and that in the majority of cases
cavitation is present by the time the disease is
diagnosed. Collapse measures in such cases may be
instituted with a view to arresting the disease and
also closing the cavity but only too often general
rest aided by the collapse treatment results in
arrest of the disease but fails to close the cavity.
The cavity persists as a potential source of
haemoptysis and of bronchogenic spread of the
disease at an early or later date, whilst being
at the same time a source of danger to the patient's
family and society.
In approaching the subject of persistent
cavities as a study for this thesis, it has been felt
that a true conception of the mechanism governing the
behaviour of cavities can only be reached when an
exhaustive survey has been made of all the possible
factors which come into play. Only when these factors
are regarded in a balanced proportion can a truer
conclusion be reached regarding the root causes
underlying the occasions when surgical means fail to
close cavities. There are no prospects that with
the advent of streptomycin, or other more effective
antibiotics, cavitation will cease to be a problem
in pulmonary tuberculosis.
The type of persistent cavity which has
been studied has been the one frequently to be found
in the chronic or arrested case. The active cavity
with progressive necrosis within its walls has not
been included for the purpose of this study.
The course of pulmonary tuberculosis is
long and hard in most cases at the best of times.
To this may be added the ordeal of a series of
operations, each one resulting in discomfort and
disappointment to the patient, months being added
to months, leading into years, whilst the cavity
persists as an ever -present source of danger to
himself and a barrier from his family and society.
All the knowledge and experience which can be
brought to bear, in order that the quickest and most
effective means can be employed early in the
treatment of cavities, will result in that much less
unnecessary suffering being imposed upon the patient.
And what is the purpose of all the treatment of the
physician if it is not to alleviate suffering?