Treatment Without Sanatorium: Including Results at Five Years

Abstract

Summary o (1) Conditions existing in Britain after the war, which led to trials of new methods of management for tuberculous patients, are briefly outlined. (2) A scheme is described involving short-term admissions to General Hospital beds, under Chest Clinic direction. Here necessary collapse therapy was initiated, followed by long-term management of patients both at home and as out-patients of the clinic. Some entered sanatoria for convalescence and a few received additional active treatment there. (3) The term ‘Domiciliary Management’ commonly used for such schemes should be replaced by ‘Clinic Management’ since they are run entirely from clinics although much of the work is done in hospital beds and some in the homes. (4) A series of 64 sputum-positive patients treated in this way and followed for five years, is presented. There are 12 B1, 41 B2, and 11 B3 patients in the group, 77 per cent of whom completed their active treatment under ‘Clinical Management’. Only 11 received streptomycin during their initial treatment and complications were negligible. (5) The five-year follow-up figures reveal a survival rate of 100 per cent for the B1 patients, 93 per cent for the B2, and 82 per cent for the B3, the comparable figures for quiescence at five years being 100 per cent, 76 per cent and 64 per cent. (6) Some of the disadvantages of sanatorium admission, and the ability of ‘Clinic Management’ to overcome these, are pointed out. In particular the attainment of continuity of treatment, the daily visiting by relatives, the complete knowledge of the home and social background, the absence of segregation and stigma are stressed. (7) It is concluded that sanatorium admission has no more beneficial effect upon the clinical course of tuberculosis than has management by an adequate clinic organization. The advantages of the latter, clinically, psychologically, socially and administratively, are such that fuller development of chest clinics, with allied hospital beds and thoracic surgical facilities, should eventually replace the sanatorium system.