BIG CHANGES ADVOCATED

Press, Volume LXXIV, Issue 22591, 22 December 1938, Page 10

BIG CHANGES ADVOCATED

TREATMENT OF TUBERCULOSIS

SURGICAL METHODS RECOMMENDED

HOSPITAL BOARD TO MAKE INVESTIGATION

Sweeping changes in the treatment of tubercular diseases in Christchurch are possible if the recommendations of Dr. I. C. Macintyre to the North Canterbury Hospital Board arc adopted. Dr. Macintyre recently returned from a trip abroad, where he invest iea ted surgical methods of treatment which he considers essential to this country in the interests both of patients and the public health generally. "In this disease many cases," said Dr. Macintyre in a report to the board yesterday, "when they reach a certain stage, develop one or more cavities in the lungs. This is a serious matter, both for the patient himself and the community at large. Occasionally these cavities, if not too large, will heal with ordinary bed rest in a sanatorium without any special means being actoptea to assist in closing them, but unfortunately a large proportion do not ciose, and unless someinmg lur- j ther is done they either increase in size and tlie case may end iataily, or the patient may become a chronic invalid with little prospect of ever earning his own living again. These people are a constant menace to others, as it is not possible to keep them indefinitely in an institution, and so they are discharged if well enough to carry on as best they can at home.

Various Methods "There are various methods whereby these cavities may be collapsed and healed, only one of which so iar has been used at the Cashmere Sanatorium. I refer to artilicial pneumothorax, which consists in collapsing the affected lung by refills of air. This is a universal method of treatment now, and it is used practically all over the world for cases that are suitable. It is the method of choice in all cases first, but unfortunately it is only successful in a limited number. Up to the present I have used this treatment with success in only, at the most, about 5 per cent, of patients. With proper facilities and with the assistance of surgery in some cases, it should be possible to increase the number of patients on this collapse treatment to at least 50 per cent. "From my observations abroad, I am' quite convinced that this method of treating pulmonary tuberculosis has come to stay. I went away with an open mind, but very conservative views on this subject. I return fully convinced that we should prepare to treat our patients on these lines, remembering always that the adoption of these collapse methods is really a confession of failure, for if we could only get the cases of tuberculosis early enough cavity formation would seldom occur, and the necessity for this treatment would not arise, but so long as conditions are as they are at present, we must try to collapse these cavities by some means or other. "It should be specially noted that money spent in this direction is expended as a method of treatment for the patient, and at the same time as a means of prevention for the disease for the community. "Before considering what facilities are necessary, it must be remembered that Cashmere Sanatorium was built, like all other institutions, simply as a place in which to house tuberculous people, and where any active treatment such as I am proposing now was not even thought of. So far, we have managed to carry on a minimal amount of collapse treatment of the simplest type under quite inadequate conditions, such as I have not seen in any other institution I have visited on this trip.

"More accommodation, more equipment, and more assistance will be necessary, but I am sure it will mean in the end more lives saved to become useful citizens again, and also—which is every bit as important—the discharge of less infection to the rest of the community. We have at last something definite to offer the tuberculous person in at least 50 per cent, of cases.

Surgery Needed "A resolution was passed by the board some time ago to the effect that the surgical facilities at the Cliristchurch Hospital should be used for any surgery in connexion with the treatment of pulmonary tuberculosis at Cashmere. At the time I thought this was the proper attitude to adopt, but I made a point of asking all the chest surgeons whom I met their opinion on this question. Without exception, they said that if the institution was within reasonable distance of a surgeon the surgery should all be carried out at the sanatorium and not at a general hospital. "In all the up-to-date sanatoria I have visited a small surgical block has been built. I am strongly of the opinion now that this should be done at Coronation Hospital. I will not go into details as to what this should consist of beyond saying that a theatre and about a dozen beds (single rooms) for patients while they are in the immediate post-operative stage would be required. "A new X-ray room is necessary, attached to the main building, and not as it is at present, away from it. where it is impossible to use the plant in wet weather. This room must be in close proximity to a small theatre, where all minor surgical procedures can be carried out under proper i aseptic conditions. A small laboratory I and doctor's office, etc.. is also urgently required, for at present the doctor's office is used for any laboratory work and also for dispensing of drugs, surely an unhappy combination. "The amount of out-patient work will increase enormously if this collapse treatment is used to any great extent, for the patients have to attend for refills of air for some years after discharge, and the surgical cases for periodical examination, both X-ray and clinical. To save duplication of X-ray plant. I think in the meantime this can all be done at Coronation Hospital, as we have been doing in the past. Some accommodation is required for this work.

New X-Ray Plant

•"At present the decision of the board is that only part of our existing X-ray plant should be replaced. I might mention here that it was installed in 1922. and is thus nearly 17 years old. Comment is surely unnecessary. I think this present decision is a mistake, and that an entirely new plant must be purchased, with full equipment, if this collapse work is to be carried on with any degree of success, or, for that matter, safety to the patient. I went into this question and saw various X-ray firms in England, and examined their equipment. I have certain suggestions to make when this comes up for consideration. "Specially-trained nurses are an essential link in this surgical treatment of tuberculosis, more particularly in the ' immediate post-operative stage, when the life of a patient is so dependent on strict attention to certain details, and later on to prevent any more chest deformity than is necessary. Great stress is laid on this aspect of the question by most chest surgeons. A junior medical assistant will be required, as the routine work will be greatly increased, and when I am away on the West Coast it would mean that the institution would

never be left without a doctor. "There is no doubt that we are badly behind the times," said Mr W. P. Spencer, chairman of the public health committee. "Some change must be made. We may need money, perhaps a lot of money, to bring our system up-td-date, but the present system is obsolete. We must have the best, not an antiquated system." A committee consisting of Sir Hugh Acland. Messrs P. Stanley Foster, ana L. A. Bennett, Drs. N. Guthrie, I. C. Macintyre, and A. D. Nelson, and the chairman (Mr L. B. Evans) was appointed to report on the question and make recommendations on buildings, equipment, and staffing.