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The principle behind this scheme was to admit selected patients
without delay to this special unit for active treatment. The patients
were selected as having firstly good home conditions where further
treatment could be continued and secondly, reasonably limited
disease. On an average these patients were in Hospital 3—4 months
only, the rest of their treatment being carried out at home under
the guidance of the Chest Physician and Health Visitors.
The methods of treatment adopted do not depart in essentials
from those in use in other Chest Hospitals. During the first six
to twelve weeks most patients are kept in bed and are given chemotherapy.
The effect of this regime, as judged by comparison of
radiographs at the end of the second month, is regarded as an
important guide to prognosis. The principle of observing a patient's
progress while at rest, before planning further treatment is not new,
but with the more speedy action of drugs this important assessment
can be made much earlier and the time spent in hospital correspondingly
shortened. The decline of artificial pneumothorax treatment
is another reason why a prolonged stay in a sanatorium is no longer
necessary for many patients. The present forms of medical treatment
of tuberculosis are safe enough to be continued at home after
starting in hospital.
By the end of the third month most patients are allowed to get
up for four hours daily. At this point their care need throw no
additional burden on the rest of the family and they can continue
their treatment at home. Their activities during the following
months are increased under the guidance of the Physician at the
Chest Clinic. The need for surgical measures is in many cases
obvious from the start, but in others it is difficult to foretell at this
early stage how far the disease will heal on medical treatment alone.
Such patients are re—admitted six to twelve months later. After a
review of their progress, which can be completed in a few days, it
is generally possible to decide whether an operation will be necessary.
The only important difference between this plan of treatment and
that adopted by many other sanatoria is that the graded return to
full activity under close supervision is omitted.
Greenwich patients admitted to Kettle well in 1953 were 49
in all and it is convenient here to review their progress as they have
now all been out of Hospital for at least one year, and some nearly
two years. They comprise 26 men of average age 29 years and 23
women average age 25 years with extremes of 16—42 years. All
these patients had bed rest and chemotherapy. Their treatment
can be summarised as follows :—