If the nerve supply to one diaphragm is cut off, that diaphragm is paralyzed and remains in a relaxed phase, that is, higher in the chest. In this way not only are the respiratory movements of the lung diminished but also, due to the rising of the diaphragm slightly in the chest, there is a small decrease in volume of the lung.
The idea is to let the lung rest so the lesions can heal. The crush’s effect is not permanent, in fact about 4 to 6 months later the diaphragm normalizes again and a recrush was usually done. If too many recrushes were done the scar tissue made the operation too difficult to do but usually (hopefully) the TB had been beaten back by then.
Hang on folks, I’m just getting started!
Next up was something called Thoracoplasty. This term refers to the surgical removal of several rib bones from the chest wall in order to collapse a lung. In the time that this surgery was commonplace, the average patient required the removal of 7-8 ribs. Most surgeons preferred to remove only 2-3 ribs at a time and thus patients had to endure several procedures before the entire thoracoplasty was finished. Yikes!
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An "X-Ray Image Showing
Lucite Balls in Chest Cavity" |
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Yet another procedure was known as Artificial Pneumothorax. This was a method of treatment which consisted of the introduction of air into the pleural cavity (the body cavity that surrounds the lungs) which collapses the diseased area, finally leading to complete recovery. This method was used in the Frank san but they used nitrogen gas. Released patients used to come back to clinics for periodic refills!
Hang in there guys I still have two more. This next one paints an unusual picture in my mind.
Another treatment for patients who had infections of both lungs is the "shot bag" method. A bag containing one pound of shot is placed on either collarbone of the patient and the amount of shot is increased 4 or 5 ounces each week until the patient is carrying 5 pounds of weight on the upper part of each lung. This restricts the excursions of the lungs, makes them quiescent, teaches correct breathing and produces partial rest for the lungs.
Okay now, here is the piece de resistance. Last but not least is what is called Plombage. Plombage was a surgical method and refers to the insertion of an inert substance in the pleural space. The technique involved surgically creating a cavity underneath the ribs in the upper part of the chest wall and filling this space with some inert material. A variety of substances were typically used and included air, olive or mineral oil, gauze, paraffin wax, rubber sheeting or bags and Lucite balls. The inserted material would force the upper lobe of the lung to collapse. Guess what? They sometimes used ping pong balls! Don’t believe me? Talk to Millie Theirrault, a semi-retired x-ray tech at our hospital. She has come across plombage patients in her job. Imagine finding evidence of ping pong balls in an x-ray, some thirty or fourty years later.
You know if this column had run a couple weeks ago most would have thought I was up to my old April Fools tricks again but I swear, every word of this is true! So I say thank God we invented streptomycin.