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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    patients from other Institutions for surgical treatment, the patients being transferred back on completion of treatment. Patients have been admitted from the L.C.C. (Grosvenor and Holy Cross Sanatoria and Winchmore Hill Hospital), Herts. C.C. (Ware Park Sanatorium), Portsmouth C.C. (Royal National Hospital), Bedford C.C. (Mogger- hanger Sanatorium), West Suffolk C.C. (White Lodge Hospital-), etc. A total of 93 patients were admitted during the year, 89 for adhesion section, I I for phrenic paralysis either additional to or in place of pneumothorax, and one for induction of pneumothorax. Patients treated by collapse therapy (1944) . . 181 T.B. negative . 131 T.B. positive on culture ... !3 ,, ,, on direct smear ... 37 Patients whose surgical treatment commenced 1943, and were completed 1944 9 (Phrenic paralysis 2, adhesion section 3, thoracoplasty 4.) Operations performed :—382 Thoracoplasty (operations) Phrenic paralysis ... Thoracoscopy only „ and adhesion tion Thoracotomy-and adhesion tion .. 4 Bronchoscopy . 4 Exploratory thoracotomy ... I Non-pulmonary operations ... 12 sec- sec- 94 89 7 171 Phrenic paralysis. Twenty-eight patients were treated by phrenic paralysis as the treatment of choice. Two of these also had a pneumo-peritoneum. In 20 patients the treatment was successful and the sputum negative. In five persistent positive cases no other form of collapse therapy was considered indicated, in two cases a pneumothorax was induced and in a third case pneumothorax failed. No case was suitable for thoracoplasty. Twenty-three patients had phrenic paralysis following failure of pneumothorax or contra- selective pneumothorax. Treatment was successful (sputum negative) in eleven cases. Phrenic paralysis was also used following abandonment of old-established pneumo¬ thorax (ten cases), to supplement collapse in maintained pneumothorax (fifteen cases), and to treat a recent basal cavity in an old thora¬ coplasty case. Artificial pneumothorax. Pneumothorax was attempted in 109 cases. Completely adherent pleura ... 24 Small free pocket only . 14 Abandoned after thoracoscopy ... 13 Pneumothorax maintained ... 58 An additional 18 patients were admitted with a pneumothorax, all of whom required adhesion section. Thoracoscopy was performed as a routine in all cases three to four weeks after induction of pneumothorax. In eight cases pneumo¬ thorax was effective without thoracoscopy, and in 68 cases adhesion section produced effective and selective collapse. Pneumo¬ thorax was ^abandoned in eleven cases in which adhesion section was impossible or insufficient to produce selective collapse, and in two cases of selective collapse following rapid extension of contralateral disease. Phrenic paralysis was performed to supple¬ ment relaxation in fifteen cases, and for the treatment of a contralateral lesion in one case. Eight patients had a bilateral pneumo¬ thorax. Sixty-four patients had negative sputum six months after collapse was effective. Five patients treated by pneumothorax were transferred to other Sanatoria shortly after pneumothorax was established, and though collapse was selective the sputum still con¬ tinued to contain tubercle bacilli. Three patients had sputum negative to direct smear but positive on culture, and four were positive on direct smear. All except one of these are still in hospital. Complications Persistent clear pleural effusion (T.B. negative) '... Persistent clear pleural (culture positive) Empyema Broncho-pleural fistula and empyema In six of the empyema cases the pneumo¬ thorax was maintained with fluid stationary and sputum negative on discharge. 5 8 2 Thoracoplasty. This was undertaken on 38 patients, in five of whom it was for the treatment of empyema. Three of the latter were dis¬ charged apparently cured with no sinus or sputum ; a fourth, who had a broncho¬ pleural fistula, has still a small drainage tube. The fifth died from lardaceous disease nine months after operation. [7]