Dissolving Disease

One of the most serious complications met in treating tuberculosis is what the doctors call empyema, i.e., the cavity between a lung and the chest wall fills with pus. Not long ago empyema was one of the commonest complications; nowadays, thanks to streptomycin and skillful surgery, it afflicts fewer than one-tenth of tuberculosis patients. But it is still true that nearly half of those it attacks do not recover.

Last week the American College of Surgeons, meeting in Boston, heard of a chemical attack on tuberculous empyema which may make surgery unnecessary for some patients, more effective for others. Drs. Louis C. Roettig and Howard G. Reiser of Ohio State University's College of Medicine reported on a treatment using trypsin. An enzyme (one of the body's mysterious chemical catalysts), trypsin dissolves dead tissue, but seems to leave the living tissue in the chest unharmed.

Injected into the infected chest cavity of six patients, trypsin produced good results in four by dissolving the mass of pus and sterilizing the cavity. In two cases where trypsin failed, the empyema was of long standing and the cavity walls had become rigid. Roettig and Reiser recommended further trial for the promising technique.

Other ingenious techniques and devices described to the assembled surgeons:

P: An electric heart reviver, developed by Drs. John C. Callaghan and Wilfred G. Bigelow of the University of Toronto. An electrode is inserted through a vein to within an inch of the heart's pace-setting node. If the heart has stopped, electric pulses set it beating again; if it is faltering, they make it beat more regularly. Used so far on animals, the "pacemaker" is ready for human tests.

P: A lung-collapsing operation in which parts of the patient's ribs are cut out, and turned over so that they lie in a concave instead of convex position. They are sewn to the ends from which they were cut, where they cement themselves in place. Worked out by Drs. Richard H. Overholt and Leo J. Kenney of Brookline, Mass., the one-shot operation would take the place of an exhausting and expensive series now sometimes needed to collapse a tuberculous lung.

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