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Tuberculosis.
I am indebted to Dr. Stradling and Dr. Price, the two Consultant Chest Physicians in the
Borough, for the following reports, from which will be seen the changing emphasis of the
portant work of the Chest clinics:
Hammersmith Chest Clinic Report.
The Chest Clinic continues to provide a complete diagnostic, treatment, and medicosocial
service for patients suffering from pulmonary diseases, which is fully used by the practitioners.
Greater details of the services available have been given in previous reports. The
tobacco diseases, Lung Cancer and Bronchitis, remain a major part of the Clinic's work and no
diminution in the flood of these is in sight - nor, indeed, is likely to be for many years. Considerable
responsibilities remain in relation to tuberculosis, and the presumption by many that
this disease has been beaten is very premature. In particular, immigration to this country has had
a marked effect on the tuberculosis situation in some urban areas: in 1955, 2% of new cases of
tuberculosis in Hammersmith occurred in immigrants, whereas in 1965 the figure was 20%.
The staff of 26, including 5 doctors, almoner, 4 nurses, 3 health visitors, 2 radiographers,
and full supporting senior and junior clerical staff, are kept very fully occupied and are often
under considerable pressure. There were 26,067 patient attendances in 1965 in the same cramped
dingy accommodation, (2 converted wards), provided 16 years ago when 14,686 patients attended.
The provision, during the year, of new benches for the waiting patients hardly compensates for
the steady deterioration of the premises. Emergency attention to the floor and to X-ray plant has
necessitated closing the unit thrice during 1965/6 for a total of 4 weeks. This sort of situation
is intolerable in a hospital service. The graph, included as an Appendix on Page 92 of the Report,
shows patient attendances during the last 15 years, since entering the present premises, together
with the establishment over the same period. Apart from the emergency attention mentioned
above, the premises have been decorated once only.
Looking on the bright side, however, it is a great pleasure to report the steady, ungrudging
service of all the Clinie staff: we are very jealous of our reputation of being one of
the happiest units on the hospital site in spite of the difficult circumstances. We are grateful
to all those units within the hospital which co-operate so closely with the Chest Clinic to enable
the provision of a complete, high quality service to the patients. There is no doubt that such a
service needs to be conducted from a hospital and thai the higher the quality of that hospital the
better the integrated service will be. It is hoped that in the future development planning of the
Hammersmith Hospital site, better housing of the Chest Clinic and closer integration with other
outpatient departments will provide an even more efficient service for the patients and their
doctors. Meanwhile, our thanks are also due to all outside services co-operating with us in our
work under present conditions. Here should be mentioned particularly those doctors referring
patients, and the District Nursing Association helping with their treatment.
A noteworthy addition, during the year, to the facilities for managing in-patients under
the care of the Chest Clinic has been the provision of two extra cubicles in the associated
Chest Ward. This has made for a much more flexible arrangement, particularly when so many very
sick patients of both sexes are treated.
In addition to their clinical duties, the medical staff have been involved in various investigatory
projects during the year: of particular interest are the continued simplification of
long-term treatment of tuberculosis, and the development of routine bronchoscopic photography
for teaching and research purposes. Teaching postgraduate students the principles of modern
chemotherapeutic management of tuberculosis is considered of highest priority in the unit, for
many of these students come from parts of the world where tuberculosis remains the Number
One health problem.
Peter Stradling, M.D.(Lond)., F.R.C.P.,
Director.
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