Monday, March 31, 2008

Dr Mulhall 1952-1986

Dr Patrick Plunkett Mulhall

“TB male patients were difficult to control”
- Dr Patrick Plunkett Mulhall

“I went to Craig-y-nos first in 1952 to assist the medical superintendent at the time, Dr Ivor Williams, and I was there until 1985. The patients were getting on very well then because in 1952 they were starting to get new drugs. I was based at Brecon.
It was a very strict regime a Craig-y-nos: strictly bed-rest, as much rest as possible and good food and fresh air.
A lot of the children spent most of their time on the balconies. Before my time there were more severe conditions prevailing when they used to be left there in the rain, snow, everything. Of course, they were covered up but they had to endure that as well.

A lot of the children also were in plaster casts for tuberculosis of bone joints and spines. Other children had tuberculous glands of the neck. They were treated by ultra-violet rays and they had a course of treatment.

Most of my work was with the adults and they spent most of their time in bed but they were gradually given graduated exercises to get them rehabilitated and continued to walk outside the grounds.

That’s how they recovered, most of them. There used to be a monthly surgical session where a surgeon– Mr Dillwyn Thomas ,Thoracic Surgeon, Sully Hospital– came to do minor operations on the patients that needed surgical intervention such as cutting fibrous tissues (adhesions) in the pneumothorax (collapsed lung) cases.

These patients were treated by pneumothorax – by insertion of air into the pleural spaces – and because of the disease, quite a number of the lung surfaces were adherent to each other and to the pleura on the chest wall, so they had to be separated to give a complete relaxation of the lung. It was collapsed down to its smallest size.

The patients were reviewed by the surgeon for possible surgery in Cardiff, in the thoracic unit, to be transferred down there. For example, people with cavities. So, it was quite a lot of activity at that time.

Most of the people in Craig-y-nos had TB of the lungs. There were only a small number who had tuberculous bones. Those were mainly children.

I don’t recall any deaths in my time. The patients were selective in that the worst cases were transferred down to surgical units and didn’t come back. Perhaps some died after they went home, but I don’t recall any sad cases of people dying there.

Streptomycin and PAS (para-aminosalicylic acid) made a big difference. It changed the outlook completely for people who had diagnosed positive TB.

Eventually, they found that people were becoming resistant to the new drugs. Then a new drug came in called Isoniazid and that was useful to help solve the problem of preventing patients developing resistance to the drugs and become tuberculous resistant.

If it was uncontrolled, it became apparent about six weeks after treatment, and if patients – particularly outpatients – took their drugs intermittently or not continuously, that could give rise to resistance very easily. It’s the problem they have in the third world.

There were only a few members of staff, like Glenys Davies who developed sensitivity to streptomycin.

Gastric lavages were necessary to try and obtain some tuberculous bacilli in the gastric juices being swallowed. It was very difficult otherwise to get a specimen from the sputum. Some didn’t have much sputum or they swallowed a lot of it.

It was important to know whether the child was positive or negative so far as tuberculous bacilli was concerned. That also dictated what treatment they should need.

It was not a very nice procedure at all for children and in those days, perhaps … I wasn’t involved in that … in these days they’d be a bit more refined now. The techniques of doing that are with simple tubes now.

Dr Huppert

Dr Huppert was a very strict doctor. Well, she didn’t seem to have much feeling in one way, and then at other times she was very kind. She was a person who lived on her own in a flat up at the top of the building and I used to have my lunch with her in the dining-room adjoining to it once a week.

She would never talk about her experiences. She came from Vienna (she qualified MD in 1923 in Vienna), and when the Austrian Anschluss came into effect she got out before that. She had polio as a child. She used to limp around, she was a bit overweight and a formidable figure to these children.

Dr Frank Wells was the first medical superintendent. He was there until 1930 when Dr Lizzie Robertson Clark became superintendent. She was followed by Dr David William Fenwick Jones who was, in turn, followed by Dr Ivor Williams. Dr Jordan (Norman Theodore Kingsley) was a chest physician in Brecon but not at the Adelina Patti Hospital, unless he went there in a consultative capacity. He was a physician to the Welsh National Memorial Association, a post I inherited eventually.

There were two secretaries, both ex-patients in the office who ran the day-to-day administration and liaisoned so well with the patients for years. Ina Hopkins is deceased, but I still get Christmas cards from Euryl Thomas who lives nearby in Abercrave.

The sanatorium originally had both male and female patients, but eventually the male patients were transferred to the North and South Wales sanatoria.

TB male patients were difficult to control in the early days of a strict regime. One anecdote I heard was about two pals asked permission from the Sister to go to see the swans in their allotted time of exercising. After several hours absent from the ward, the two lads arrived back looking the worse for wear, and on being asked where they had been, informed the Sister that they had been to see the ‘swans’ playing at their home venue in Swansea! Who can blame them?

Dr Mulhall was interviewed by Dr Carole Reeves, Outreach Historian with The Wellcome Trust Centre for the History of Medicine, University College, London.

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