In deciding on an operative course in cases of pulmonary tuberculosis, there should be a full review of the progress of the disease from the beginning and a particularly careful study of the rapidity and character of the changes that have occurred during the last two or three months. Treatment by pneumothorax will probably have been instituted and its result should be known. In addition to this clinical picture, a roentgenologic series is necessary. With all the data in mind, the type of operation or combination of operations may be selected from some kind of thoracoplasty, phrenic nerve avulsion, pneumonolysis or a direct procedure on the lung.
The favorite practice at the present time is to perform paravertebral thoracoplasty as elaborated by Sauerbruch, the details of which it is not necessary to review. This operation may be performed in one stage or in a series of stages, according to the