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108
There have recently been revolutionary changes in the treatment
of pulmonary tuberculosis. Streptomycin and para-aminosalicylic
acid having become freely available, the use of these
substances has had a profound effect not only in reducing mortality,
but also in enabling advanced cases to be so improved as to be
brought within reach of collapse treatment which would otherwise
have been impossible. A further new drug of great promise, isonicotinic
acid hydrazide, is at present undergoing trials in which
several Greenwich patients are included. There have been great
advances in the surgical treatment of tuberculosis.
Coinciding with improved methods of treatment have been the
more widespread use of mass radiography in the detection of unsuspected
cases and the introduction of B.C.G. as a preventive measure.
The most important fact to be singled out from the tables which
follow, is the remarkable fall in the death rate which in 1951 was the
lowest ever recorded in Greenwich.
At the beginning of 1951, the waiting list for admission to
Sanatoria and Chest Hospitals was very long, patients often having
to wait 18 months for treatment. By re-organisation this waiting
time has been largely eliminated. Some admissions are now
arranged direct with the hospitals concerned and not through the
central office.
A short term treatment unit for early cases has been set up at
Kettlewell Hospital, Swanley, and patients are admitted there
within 2 weeks of tuberculosis being diagnosed. Twenty-eight
patients were admitted there during 1951, and the majority of them
had returned home within 3 months, the active part of their treatment
having been completed. This scheme has undoubtedly been
an outstanding success.
The waiting time for general treatment had been reduced to
about 8 weeks by the end of the year and some 50 patients were
admitted for long term treatment to such Sanatoria as the Grosvenor
at Ashford, Lenham, Fair light, the Royal National at Ventnor, and
the Eversfield Chest Hospital, Hastings.
The centres for major thoracic surgical treatment of tuberculosis
are at Grove Park, and Preston Hall Hospitals. Pneumonectomy,
lobectomy, plumbage, or thoracoplasty has been carried out on
25 patients during the year, with only one death. A surgical unit
for non-tuberculous chest diseases has now been opened at the Brook
Hospital. Close liaison has been established there and several
patients from the Clinic have been admitted for treatment of lung
carcinoma and bronchietasis.
Pleural effusions are sent to the special unit at Queen Mary's