Report of the Committee of Management and Medical Director : 1944 / Papworth Village Settlement.

  • Papworth Village Settlement (Cambridge, England)
Date:
1944
Catalogue details

Licence: Public Domain Mark

Credit: Report of the Committee of Management and Medical Director : 1944 / Papworth Village Settlement. Source: Wellcome Collection.

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    I. GENERAL MEDICAL STATISTICS Men. Women. Total. Admissions . 342 179 521 Discharges 342 175 517 Average number of beds occupied during the year. 354 158 512 Total number treated... 692 341 1,033 Service patients treated 143 8 151 Number of patients colonized 24 17 41 II. SURGICAL UNIT The Nelson-Langermarsn Hospital j.B. Hunter., M.C. M.Ch, F.R.C.S., Hon. Thoracic Surgeon. F.L. Wollaston, M.R.C.S.,L.R.C.P., Resident Surgical Officer. H.N. Webber, M.R.C.S., L.R.C.P., D.A., Hon. Anaesthetist. During the past three years there has been a great increase in the number of patients admitted for treatment. This has been due to two causes: (!) the number of pensioners that have been admitted direct, and (2) the increased use that is now being made of Collapse Therapy in all its forms in the treatment of tuberculosis. There has been an increase of 60% of Collapse Therapy treatment, and this has tended to centre round the surgical unit. Every patient on admission is considered by the whole medical staff, including the resident surgical officer, and if a decision is taken , that a case is suitable for Collapse Therapy such cases are under the direction of the surgical side, the policy being to obtain effective collapse by the fuli employment of all available surgical methods. If pneumothorax is ordered the case is reviewed three weeks after induction, and unless the pocket is too smali to admit a thoracoscope, or alternatively, collapse is completely efficient and no adhesions can be seen, a routine thoracoscopy is performed. By this means selective collapse has been obtained in 68% of cases in which A.P. was induced, and in many cases of ineffective collapse adhesions have been found that did not show on X-ray. When selective collapse has been obtained the patient is kept in bed until the X-ray does not demonstrate a cavity and the sputum is negative, where¬ upon the patient follows normal sanatorium routine, though throughout his stay in Papworth routine X-rays are taken and seen by the surgical officer. If the collapse cannot be made selective or the cavity does not close and the sputum become negative, the case is again reviewed and submitted to the Consulting Physician and Consulting Surgeon. If phrenic paralysis is considered to be the treatment of election a phrenic crush is performed. The patient is kept in bed for a period of from one to three months and reviewed at monthly intervals. If the result is satisfactory the crush may be repeated when a flicker begins to appear in the dia¬ phragm on screening, but if it is not fully effective as indicated clinically, radiologically or bacteriologically, other Collapse Therapy is considered. If other methods of Collapse Therapy have failed, the case is submitted to the Consulting Surgeon with a view to more extensive therapy, such as thoracoplasty. A period of bed rest and observation is regarded as essential preliminary to thoracoplasty, and sometimes a course of gold is given. In others a contralateral pneumothorax is induced where there is a suspicious focus in the “good ’’ lung. Patients are transferred to the Surgical Unit for a period before the operation so that they become used to the surroundings and staff. As there is no waiting list, patients can be operated upon at the optimum time when resistance is con¬ sidered to be at its peak. After operation they are kept in bed for a minimum period of three months, and then transferred to the Sanatorium Blocks. As the aim of treatment is to secure effec¬ tive collapse it often happens that a patient is treated by several successive procedures, starting with an attempted pneumothorax, a phrenic crush and then thoracoplasty. In certain cases where pneumothorax has failed and it is not considered advisable to proceed straight away to thoracoplasty, a phrenic crush is undertaken together with a pneumo¬ peritoneum. The results of treatment of all cases who have undergone any form of collapse therapy during 1944 are submitted. 73% were discharged from the treatment unit with negative sputum. Assessment was made on discharge or transfer to rehabilitation section, or, in unsuccessful cases, at a period of not less than six months after the com¬ pletion of surgical treatment. In addition to the surgical treatment of Papworth patients the Unit has admitted [6]