Older Methods of Treating TB
Plombage Therapy
“Ping-Pong Ball Plombage”

·        Early treatments of TB relied upon rest, proper nutrition and isolation

·        In late 1800’s, concept of artificial ptx introduced by Carlo Forlanini of Milan

o       Speculated on the feasibility of collapsing lung by introducing air into the pleural space

o       Intentional production of a lung collapse was thought to allow the lung to rest

o       It usually did nothing except to worsen the condition of the patient

o       By early ‘40s, thousands of refills (reinjections of air) were being done each year to maintain collapsed lung

·        Pneumoperitoneum to rest the lung followed in the late 1940s

o       These techniques were often combined with phrenicolysis (crushing or surgical division of the phrenic nerve) leading to ipsilateral paralysis of the diaphragm.

·        There were other procedures such as thoracoplasty and plombage

o       Thoracoplasty was more permanent form of collapse therapy in which several upper ribs were removed

o       The chest cage was then pushed toward the mediastinum, collapsing the upper lobe

·        Plombage involved the extrapleural insertion of a “plombe” to collapse the lung. They included:

o       Fat

o       Solid paraffin wax

o       Lucite spheres

o       Plastic ping pong balls (1940s)
 

Multiple round ring-shadows in RUL are plastic balls
inserted into the pleural space to collapse lung

o       Sponges of inert plastic material

o       Oleothorax

§         Oil in the pleural cavity

·        Sanatorium movement began slower in US than Europe

o       Once started, many opened and became a major way of treating TB

o       In 1953, 839 TB sanatoria in the USA stressing

§         Diet

§         Regimented exercise

§         High altitude

§         Bedrest

§         Sunlight

§         Cold air

·        Chemotherapy began in mid-1940s

 

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