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George V. sanatorium with sputum T.B. negative, and that there is reason to
believe that the survival rate after five years is about 10 per cent. higher than it
was 10 or 12 years ago.
In this work the facilities provided by the opening of the operating theatre and
new X-ray department in the autumn of 1933 have proved invaluable. During
1934, 3 operations of thoracoplasty, 8 of apicolysis, 30 of phrenic evulsion, 38 of
phrenic crushing, and 18 of thoracoscopy for cutting adhesions were performed by
the visiting chest surgeon. In addition the visiting ear, nose and throat surgeon
performed 4 tonsillectomies, 1 radical mastoid operation, and 1 submucous resection.
Treatment by artificial pneumothorax is carried out in approximately a third
of all the cases. The exact number commenced in 1934 was 143, and the total number
of refills was 3,657. Sanocrysin or other salt of gold was used in 37 cases.
The medical superintendent of Pinewood sanatorium (Dr. Fowler) has reported
as follows:—
Full use, as far as the clinical material demands it, is being made of artificial pneumothorax
treatment, gold salts, and phrenic nerve paralysis. The idea of obtaining a really good collapse,
both clinically and anatomically, is increasingly pursued by means of thoracoscopy and adhesion
section. Oleothorax has been little used because of the diffidence of institutions dealing with
the patients after they leave here to carry on with the occasional refills required. Some of the
old cases of oleothorax come up to Pinewood regularly for observation and refills, and all of them
are doing well.
The medical superintendent of Colindale hospital (Dr. Heaf) has reported as
follows :—
Treatment has been continued along the same lines as in 1933, but in a more intensive
manner. Collapse therapy has been applied to cases wherever possible and major surgical procedures
have been used more extensively, due regard always being taken of the resistance of the
patient to the infection. Considerable benefit has been obtained from temporary paralysis
of the diaphragm by crushing the phrenic nerve instead of permanently eliminating its action
by evulving the nerve. This treatment is particularly valuable when combined with absolute
rest.
Treatment by gold salts is still considered beneficial in certain cases.
The throat department has still been favoured by the help of Sir James Dundas Grant.
Ultra-violet light therapy has been supplied directly to the larynx in 25 cases, and it
has been noted that it gives some relief to dysphagia and favours the formation of fibrous tissue
in areas of infiltration. This work is being continued.
The number of ex-patients continuing their artificial pneumothorax treatment at the
hospital was 82 during the year. This number is gradually increasing.
The following statistics show the number of cases treated by special methods during 1934 :—
Major surgical methods— S.M. resection 1
1st stage thoracoplasty 12 Antrum washout 1
2nd stage thoracoplasty 9 Kromayer U.V.L. application to
3rd stage thoracoplasty 2 larynx and ulcers on tongue, etc.403
Apicolysis (wax implant 2 Out-patients attending for throat
Adhesion sections 17 paintings 9
Thoracoscopy 4 X-ray department—
Orchidectomy 1 X-ray photographs 1,228
Inguinal hernia 1 ,, ,, staff 112
Minor operations— Out-patient department—
Phrenic evulsion 33 No. of patients for A.P. refills 82
Phrenic crushing 45 „ attendances for A.P. refills 625
Rib resection 2 „ patients for throat treatment 9
Aspirations and minor operations 112 „ attendances for throat treat- A.P. refills 2,311 ment 72
Throat department— patients for sanocrysin 2, —
Cauterisation of larynx 8 attendances 24
„ ear 1 Mercury V. U.V.L. 400
Injection of superior laryngeal nerve 5 Infra-red radiant heat 396
Application of chaulmoogra oil and Dental department—
Argyrol, 50 per cent. 437 No. of patients received treatment 647
The weekly clinic, at which cases requiring special treatment are discussed, has been held
regularly throughout the year and has been attended by 64 visitors. The clinic is becoming
increasingly valuable in checking over-enthusiasm for any special line of treatment and in making
a more accurate prognosis of cases.