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21
Rehabilitation
The regular monthly sessions between the chest physician, almoner, Disabled
Resettlement Officer of the Ministry of Labour, and the patient, have continued
throughout the year and have proved very satisfactory
Non-Tuberculous Chest Disease
Cancer of the Lung
During the year considerable efforts have been made to speed up the diagnostic
facilities available to the general practitioner with particular reference to the need
to discover the first signs of carcinoma at the earliest possible stage. This has
been possible with the assistance of Dr. L. Grant who carries out a bronchoscopic
session each Wednesday afternoon at the Western Hospital, On several occasions during
the year it has been possible, with the assistance of the Mass X-ray Unit, to ensure
that the interval between the time when the patient is picked up by the Mass X-ray Unit
and the time when they are admitted to a bed in the surgical unit or radiotherapy
department is not greater than 10 days. I think we should aim to reduce this period
still further in the near future, since it is only in the very early stages that any
hope exists of effecting a cure at present.
Chronic Respiratory Disease Clinic
This aspect of the clinic has developed apace during the year and has centred around
two clinical trials The first was the ammonia trial, which was a repeat of the one
carried out the previous year in association with a bronchitis working party of the
Medical Research Council, The second trial was one designed to test the efficacy of an
autogenous oral vaccine in the prevention of the acute episodes in chronic bronchitis.
An attempt has been made over the last two winters to evolve a scheme of rapid
evacuation of such cases out of London, reducing as far as possible the stay at any one
centre, so as to facilitate rehabilitation and keep beds at the centre free Our
experience here seems to show that the maximum benefit is obtained in the great
majority of cases in 10-14 days and that a longer stay than this does not appear to
improve the general wellbeing of the patient or lessen the chances of a relapse on
return to London Both the Chest Clinic and the Bronchitis Unit at King George V
Hospital are equipped to carry out the normal ventilation tests now employed The
Unit at King George V Hospital can also investigate diffusion defects and the two units
are working in close co operation.
Chronic Cardiac Abnormalities
A varied number of cases of chronic cardiac failure were seen during the year and
E.C.G. examinations carried out some at the request of local practitioners. Where
necessary some of these cases were referred to the cardiologist.
Results of the Ammonia Trials
Despite the fact that many seriously handicapped patients professed to great
relief from the use of an ammonia bottle, especially in foggy weather, the analyses of
the results from the treated and control groups during the winter of 1956-7 showed no
statistical significance between the degree of illness, the amount of sickness absence
or the proportion of those going off sick in each of the two groups Similar results
have been obtained this winter when the total group of patients was re-randomised and
stratified for age and sex and when the overall weather conditions were more severe
than in the winter of 1956-7. It would appear' from the results of these trials that
the effect of using ammonia vapour to neutralise the sulphuric mist in the London
atmosphere during the winter months does not materially affect the course of the
disease in a random sample of bronchitics, although it subjectively benefits an
unselected group.