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The 43 patients who had consulted their doctors on account of
symptoms tended to have much worse disease on diagnosis than the
35 picked up by routine radiography.
Treatment.
There have been no great changes in treatment during the year,
and at no time has any patient had to wait for admission to hospital,
sanatorium or thoracic surgery. The combined hospital-home
treatment schemes have continued most successfully and half the
78 new cases seen were treated in this way, being in hospital for
3-4 months only until their disease was under control, and then
continuing rest, chemotherapy and upgrading at home. There
are, of course, critics of these methods of management of tuberculosis
who say that by by-passing full long-term sanatorium treatment
one's treatment of the individual patient is bound to fail.
The experience of the past 5 years at the Greenwich Chest Clinic
has clearly demonstrated that by careful selection of patients and
their home background, fully 50% of the new cases seen can be
treated entirely successfully in this way.
Streptomycin, P.A.S. and Isoniazid continue to be the drugs of
initial choice in the treatment of tuberculosis, and the tendency is
to give longer and longer courses of these drugs, a year being about
the minimum time.
Artificial Pneumothorax has now been entirely abandoned as
a method of treatment, but a few patients still have pneumoperitoneum,
a useful method in a few cases. Twelve patients had major
chest surgery during the year—all resections.
With modern methods of treatment, including chemotherapy,
the time a patient needs to be in Hospital has been very much
diminished. For patients not requiring surgical treatment the
average time is now about four months and for those needing surgery
9-12 months.
In 1955 it was reported that a small number of patients, specially
selected because of their limited disease and non-infectivity, were
being treated by chemotherapy without rest. In 1956, 28 new cases
of minimal tuberculosis were treated in this way by being given
chemotherapy and allowed to continue at work, with entirely satisfactory
results so far. In addition 21 old cases who had small reactivations
of disease were treated with ambulant chemotherapy,
again with very satisfactory results. It is realised that this is a
revolutionary idea but results so far have quite justified ambulant
chemotherapy as a method of treatment of some cases of tuberculosis.