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Does a Lung Cavity Ever Heal Spontaneously?: G DOES A LUNG CAVITY EVER HEAL SPONTANEOUSLY?: G. C. CHATTERJEE 472 THE INDIAN MEDICAL GAZETTE [Aug., 1941 DOES A LUNG CAVITY EVER HEAL of tuberculosis, it behoves one to consider whether a ever SPONTANEOUSLY ?* cavity heals spontaneously, and, if it does, under what conditions and how, so By Rai Bahadur G. C. CHATTERJEE, m.b. (Cal.), that, guided by this knowledge, the physician Hony. f.r.i. (Lond.) may avoid, in such cases, surgical interference, with its attendant risks. It is also necessary In view of the very extensive proce- surgical to whether interference here has dures that are being adopted in the treatment enquire surgical the same curative as the removal of the * value, Abridged by the Editor. septic joint or limb, or an appendix which re- moves for all time the causative element from the system altogether, or whether it is done to help in the fight against the germ of tuberculosis which was begun long before the operation and will be continued for even longer after the operation. A quotation from one of the most outspoken writings of an advocate of one type of surgical interference (operators are not unanimous in selection of their procedures, one set condemn- ing the other's procedure), namely partial thoracoplasty, or apycolysis, as it is termed, will give us an insight into their line of thought- Coryllos (1935) the advocate of this method m says, in justification of applying his method curing cavities, the following :? ' Instead of being a passive observer of letting nature act and hoping for the best, he (the surgeon) lS becoming an active, daring, open-minded and scientific crusader, his immediate objective is the definite, early and economic cure of tuberculosis patients. His further aim is the eradication of the disease by early suppres- sion of tubercle bacillus carrier. The objective of the method devised for the purpose is not only the cure of the disease, but also the preservation of the anatomical and physiological integrity of the healthy part of the lung. These procedures represent the modern ideas, actual trend and tendency in the treatment of pulmonary phthisis.' Though the natural interpretation of the above lines taken from its context would sug' gest that this operative procedure is the only method advocated by the above writer, for all cavities and with it tuberculosis of the system* yet, to do justice to the writer, I must say that o* lie admits in the same paper the occurrence spontaneous cure of a certain type of cavity which should not therefore be upon operated a and also that there is difficulty in recognizing cavity by ?-ray, for example in annular absorp' tion of an exudative lesion which very p^el1 simulates a cavity. Lastly, in general criticip111 of thq above assertion without going into detail5' it is necessary to state also that the operatic0 procedures are changing from year to yealj newer methods are continually being advocate by fresh workers. For example, apycolys1^ advocated by the above writer has a reputatio of not more than five years and, even within wertn1^ limited period in some of his cases which operated upon by this method with expectatm *' The acute benign exudative productive tuberculosis of Ulmar andfo?S?xier, pulmonary Ornstein, a heals as a rule spontaneously by bed rest alone requires no surgical interference, so also the c productive form of Omstein and Ulmar. The QueSiiecI of cavities is complicated by the existence of so-ca annular shadows.'?Coryllos (1935). Aug., 1941] DOES A LUNG CAVITY EVER HEAL ? : CHATTEKJEE 473 of not complete cure, the tubercle bacilli did take place?the activity of the invading germ in isappear and others have flared up ending may break down the resistance and may destroy ^atli. So the above sweeping assertion that the organism. The former condition is under "?se operative procedures will cure cavities, consideration here, where, as a result of localiza- with them tuberculosis, is not supported tion of the disease, the system became immune, y facts. Moreover, the finding of a large completely or partially, to the further inva- umber of cases with cavities, who have not been sion of the germ. When this immunity was in operated upon at all remaining healthy for process of taking place, the physiological condi- v ears (for 20 years or more) with subsequent tion of the patient improved, and he started l^ppearance of cavities, as proved by a;-ray, picking up in health. The lesion became , make one wonder whether the fibrosed here a concrete illustration of 0 optimism giving rely on sanatorium treatment only has how immunity is produced, the surgeons a better basis in fact and whether the con- fixing their attention entirely on the re-ray find- treatment should be set aside lightly and the fact that the was in rfa^Ve ings ignoring cavity favour of the above procedure. getting fibrosed. It could not be made out by , ?o, without discussing further the merits and .T-ray alone that he was healing by himself, in of operative procedure, I will describe spite of the surgical interference, which was 0eillerits I 1ne ease among several others with which unnecessary; they did not in fact succeed in a^e had to deal where this spontaneous healing what they aimed at, namely, immobilization of to?k place. the lung by putting air into the pleural cavity. Summary of one case The next question to be decided is whether all n?lc-?The patient, aged 35, who was employed cavities left after of the disease be- business firm 'in stated that his weight quiescence hef' Calcutta, come obliterated fibrosis as in this complaint started was 112 lb. He suffered at by happened first or remain as 0111 Pleurisy in the right side, for which he case, open spaces, with the sword undp. no 1Went some form of treatment but there was of Damocles hanging over the patient's head, fev r he only l0Sf n9r did it incapacitate him for his work; as at any time the unsupported arteries around ^~e suddenly one day started after an the may burst and lead to instantaneous attaot61^-influenza bringing out a huge of blood cavity and k quantity or g unrelieved artificial whether metastasis will take PQei. by ordinary treatment, death, secondary (A-P) was performed, and as this appa- from caseous unhealed in the rent]rnothorax for place portions comii ftoPPed the haemorrhage, he was persuaded, walls of cavities. Though these dangers are not e cure of his disease, to take further A-P (as Will on groundless (I have seen one case later, air could not be introduced absolutely acC0,aPPear in this the fact remains that in ?f adhesions, so this was more or less a show). dying way), yet X)Ur: films this period, covering two years, two .r-ray many patients with whom the writer has had to en: a ? one showed infiltration and the second deal the cavities have not This fact cavit not collapsed. ln *he apex. Finding that he was gettjiT ri?ht has been found out only by ?-ray taken more 1 the went to a sanatorium situat 9ured, patient a ln a station where the doctor in charge, out of curiosity long time after the active takin r an?ther film, agreed in the opinion of the have passed away, the patients Previ^ as symptoms being ^octor that there was a huge cavity, but at that time in of health and there?USWere enjoyment perfect adhesions he said A-P was not possible. without physical signs. nerve avulsion was advised but not done; thenllG.n*c started giving him calcium and gold. As So the conclusion to which we come is that and fever followed this line of treatment, the , healing by fibrosis of the cavity takes place, came out of the as a case ?f ti u hospital, hopeless the camec with healing of the tuberculosis of the ' his funds ?-o exhausted, uacjc l;5r,cV'?.sis+ u- and, being back 1S home to die. He in for two years, in many cases and is a of Whpr, t lay bed system, part ordinary * saw him for the first time in March 1940; he so \vas , healing process. Whether it does in all cases, *n of but had a enjoyment good health, it is not possible to say. iri.)aKP5ren^y in regio dly crepitant patch the right supra-clavicular ac(iomPanied with cavernous breathing. As I [Note.?As Dr. Chatterjee has been one of the leading for for he in the anti-tuberculosis movement in and haj ri n? justification making him lie down, spirits Bengal .r' I encouraged him to come to my clinic, has had considerable experience, we feel that we must Avhir>i??i. that this treat- time ye did three months after I saw him. At allow expression of opinion on the surgical 144 no ment of whom Ave u f?und his weight lb., crepitant patch tuberculosis, though many, amongst c?uld on breati ? found in the apex, but, in its place, blowing include ourselves, will not agree with him this no and no fever. increased by ,v , cough Weight subject. tuberculin treatment from 144 to 151 lb. He case a Was nki The he quotes is a good example of how fever to Walk a good distance without getting any cavity may heal up without treatment. It is also a sad ^ken !+nd there were no physical signs. An x-ray story that?on the face of it for the evidence rests showed the fibrosed remnant of on the the ni 1 period mainly statements of the patient?suggests side (plate w*th ^eart drawn to the left malpraxis on the part of one doctor, culpable \XyjY condonation on the part of another (sec appendix), and extreme gullibility on the part of the patient.
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