War Surgery and Medicine
Results of Treatment
Results of Treatment
All will agree that the best results of treatment should be obtained in the cases diagnosed early, for whom institutional treatment if required is available without delay, and who are relieved of financial worry should it be advisable for them to cease work. Except for prisoners of war, these two latter conditions existed for service personnel, and in over 40 per cent of cases the first condition was also present as they were diagnosed by routine X-ray before the patients were aware of any illness.
In the treatment of the 1404 cases under review, some 300 required no treatment but were merely kept under observation at the chest clinics. On the other hand, in addition to inpatient observation in sanatorium or hospital required for the remaining cases, the following operative procedures were carried out:
Thoracoscopy with pneumolysis or attempted pneumolysis, 33 cases.
Artificial pneumothorax was produced in 316 cases.
Pneumo-peritoneum was used in 22 cases.
Phrenic crush or avulsion was carried out in 54 cases.
Thoracoplasty was carried out in 27 cases, and 5 cases are at present in hospital for consideration of this operation.
While the production of an artificial pneumothorax was the commonest form of active treatment, more than one of the above procedures was carried out on the same patient in certain cases.
The classifications under which the results of treatment are tabulated have been used as an interpretation of the findings and reports of medical examiners. In examining patients for reports on any indications for treatment and assessments of degrees of disablement for pensions purposes, examiners do not always use the terminology used by the Health Department. Thus, in interpreting reports, it is felt they fall under the following headings:
Apparently cured, where the examiner states there is no disability and recommends cessation of pension, or suggests a permanent minimal pension for a lesion healed and stationary for some years and requiring no further observation.
Quiescent cases, which on examination appear much the same as the above but, owing to the short period the condition has appeared healed, a more conservative view is taken and observation for a further period at long intervals is recommended as a safety measure.
Stabilised cases, where any evidence of progressive disease has been removed but treatment and observation are still required. Included in this group are such cases as those where ‘soft’ shadows have hardened and where an artificial pneumothorax wholly controls the disease but the lung is still collapsed by introduction of air. The patient is allowed to follow his occupation provided it is of not too heavy a type, and if so, he is advised to seek another job in the meantime.
The active class, where the disease is still active even if responding to treatment. The patient is attending for treatment at a clinic or under domiciliary treatment.
Cases in hospital or sanatorium. Admission may be temporary for special active measures in treatment or may be in certain hospitals for an indefinite period owing to extensive and progressive disease not responding to treatment.
Deaths in this series of patients which may be due to pulmonary tuberculosis or other causes. There have been four deaths in the series not due to pulmonary tuberculosis.
Using the above classifications, the following table sets out the results for various groups of the services, giving the percentage in each group for total cases from 1939 to 1949.
|Apparently Cured Per Cent||Quiescent Per Cent||Stabilised Per Cent||Active Per Cent||In Hospital Per Cent||Dead Per Cent|
|All services, overseas and New Zealand||29.3||21.8||17.7||15||10.4||5.8|
|Cases diagnosed by routine X-ray, all services||39.6||20.4||15.6||14.2||7.1||3.1|
|Cases diagnosed by routine X-ray, army overseas||40||22.72||12||14.6||7.1||3.6|
The 193 cases of pleurisy with effusion were included in the survey because the clinicians considered them tuberculous in origin. The results of treatment showed that cases with a sudden onset did well, whereas the rarer cases with a slow insidious onset did badly.
Females: Among females there were 45 cases, 10 with overseas service and 35 with home service only, and there was one death in the Navy in New Zealand. The large majority (29 cases) were aged 20–25. Results of treatment in this group were excellent—23 cured, 8 quiescent, 4 stabilised, 8 active, and 1 in hospital. Some 15 cases diagnosed by routine discharge X-rays had not required institutional treatment.