Decortication in Unresolved Tuberculous Pleurisy with Effusion and Empyema

Introduction  Since 1946, decortication has been performed with increasing frequency on tuberculous patients. Gurd¹ and Mulvihill * were among the first to present encouraging reports about decortication. Decortication has been advocated not only to remove fibrocaseous intrapleural residuals but to improve pulmonary function.† Streptomycin has certainly made this operative procedure safer.Our experience in treating pulmonary tuberculosis in Army Chest Centers has led us to believe that maximum drug effect in pulmonary tuberculosis takes place at about eight months of combined chemotherapy. In the past, in accordance with this clinical finding, we have decorticated patients with unresolved tuberculous pleurisy and empyema after six months to one year of drug therapy. This has been, in some instances, as late as from nine months to one and one-half years following onset of symptoms. It was felt that the procedure was safer at this time because the activity of the tuberculous process was