Observations on Some Epidemiological Factors of ...€¦ · Sept., 1939] EPIDEMIOLOGICAL FACTORS OF TUBERCULOSISi SANJIVI 527 OBSERVATIONS on SOME EPIDEMIOL- OGICAL FACTORS OF TUBERCULOSIS.

Sept., 1939] EPIDEMIOLOGICAL FACTORS OF TUBERCULOSISi SANJIVI 527

OBSERVATIONS on SOME EPIDEMIOL- OGICAL FACTORS OF TUBERCULOSIS. tat o^TTrT,TT T^TT^T1 yy IN SOUTH INDIA

(As STUDIED FROM CASES AT THE GOVERNMENT Tuberculosis Hospital, Madras)

By K. S. SANJIVI, m.d.

(Madras Medical Service)

sioi HIS ^aPer a^tempts to draw certain conclu-

ciil18? 0l] ^le ePidemiology of pulmonary tuber-

tiv0818 m an analysis of a thousand consecu-

st G,. ?J)en cases and a thousand radiographs, tut

1

a r^le Government Tuberculosis Insti-.

T ki rra?' durinS 1936-37.

one 3 gives the age incidence of the 1,000 n eases, 709 males and 291 females :?

Table I

Age

fess than 15 15-24 25-34 35-44 45-54 55-64 Above 84

. It will be seen that high tuberculosis morbidity

ln females starts a decade earlier than in males and does not appear to be so much a problem in ?, i'ly women as in elderly men. That moie ^an 10 per cent of male consumptives are past

years is an important fact to be remembeied, a large number of them pass off as chronic

"rachitics; 6.9 per cent of all the cases had Wheezing at the time of examination. It is

remember that 1 all that wheezes is not

asthma'. The importance of this distribution 0 the economic life of the community by 83.3 ?r cent of the ailing men and 91.9 per cent of le ailing women being between the ages of 15 a*Kl 44^ js j-0Q obvious to be dilated upon*.

figure 1 shows that tuberculosis is no longei ??*fined to urban areas. This rural permeation

?nly to be expected, considering the rapid

^These figures do not present the true sex ac tion of tuberculosis, but only the distribution Jjjongst those attending the tuberculosis institute, hn,? ,ec?uomically more important members ot a first would tend to apply for medical relie ^??Editor, I. M. G.]

[/communications that exist to-day, the frequent exchange of men between the fields and the factories, and the comparative virgin state of the soil in the villages.

The 709 males have been classified below

according to their occupation

Table II

Showing occupational incidence of tuberculosis

Farmers .. S9

Coolies .. 71

Mill-workers .. 55

Clerks .. 45

Food-handlers (milk- men, cooks, bakers, etc.) .. 45

Petty merchants .. 39

Peons .. 24

Domestic servants 24

Press-workers .. 23

Students .. 21

Teachers .. 18

Gold- and silver- smiths .. 16

Weavers

Tailors

Sweepers Motor-drivers

Carpenters Blacksmiths

Beedi- makers

Masons

Policemen

Cartmen

Fishermen

Painters

Unemployed

Miscellaneous

15

15

15

15

14

13

12

7

5

71

33

When we consider the numbers actually engaged in each of these occupations (of which we have no accurate information) perhaps tuberculosis surveys amongst mill-workers, press-men, tailors, beedi-makers and weavers are likely to yield valuable data.

Whenever tuberculosis is diagnosed in an upper class family?and it is by no means rare among them?one hears loud protestations that it cannot be, as there has been no previous family history. Even so, how can the richest escape tuberculous infection when the food- handlers and children-handlers (teachers, ser- vants, motor-drivers, ete.) form as much as 16.7 per cent in the above table.

6 3-4% UPBAN

Fig. 1. Fig. 1.

528 THE INDIAN MEDICAL GAZETTE [Sept.,

Table III

Shoiving death rate of children of tuberculous persons

Males

Females

Num- ber

married

354

216

Number of

children born

1,324

623

Number of

children (under

10 years) dead

528

164

Percentage dead

39.9

26.3

The percentage death rate for children under 10 in the general population is 4.0 (Russell, 1938)*. The death rate in the children of tuber- culous parents is considerably more. The definitely greater risk to the offspring

when the open case is the father may be due to two reasons :?

Firstly, an incapacitated parent stays indoors all the time, and,

Secondly, the set-back in the economic level of the family due to the bread-winner's illness tells on the resistance of the children.

Of the 216 married women, 58 or 26.9 per cent dated their symptoms from a previous child- birth or abortion. Tuberculosis should not be forgotten in the differential diagnosis of fevers in child-bed. The number of the pregnancies did not appear to be of any significance.

Table IV

Showing the duration of the disease at the time of seeking treatment at the institute

Number of

cases

Less than 15 days .. 32 15 days to 1 month 87 1 to 2 months .. 119 2 to 3 ? .. 133

Number of

cases

3 to 6 months .. 265 6 to 12

? .. 175 More than 1 year 189

It will be seen that only a third of the total have sought treatment earlier than three to six months after the manifestation of symptoms. Unless something effective is done to avoid this general delay it will be difficult to convince people that tuberculosis is curable.

Table V

Showing the initial symptoms complained of in these 1,000 cases

Fever alone .. .. .. 73 Cough alone or with weakness .. 405 Fever and cough .. .. 386 Haemoptysis .. .. 40 Loss of weight or weakness .. 58 Pain in the chest .. .. 28 Dyspepsia .. .. 10

Apart from the cases of initial hssmopty? >

224 others had spat blood some time during ^ illness, haemoptysis thus occurring in 26.4 P cent of all the cases. The importance of

11

ignoring a persistent unexplained cough, *eV,iy weakness or hamioptysis must be urgen

)

brought home to the general practitioner, j51 ^ will educating the general practitioner a } ensure diagnosis ? From table VI it will be se that 49.7 per cent in this series had tried vari?

non-descriptive, non-allopathic remedies t>e*

coming to the tuberculosis institute.

Table VI _

Allopathic hospital or dispensary .. 406

Allopathic private practitioner .. Non-descriptive remedies .. ^97

This takes us to the larger question of or&a ization of medical relief for the poorer c^a^u"e' which is outside the scope of this paper. fact that 82.7 per cent of these 1,000 open

ca

had gone beyond the stage of suitability artificial pneumothorax further illustrates urgent need for facilities for early diagn?^ and treatment. With the very meagre in*3tl., , tional accommodation we have, the vast ma^irpjr of these advanced cases are turned back to t

homes where conditions are ideal for the rap g dissemination of the seeds of tuberculosis. means of segregating the advanced open

ca

must, therefore, form a vital part of any P

gramme of tuberculosis control. , ^j]e Every case which, on a consideration oi

symptoms, Mantoux test, sputum exarninajpnt and clinical examination by two indepen'a observers (the assistant surgeon and the

di

tor) appeared to be a case of pulmonary tu ^ culosis in whichever stage was .T-rayed. ln ^e country sifting of other evidence has to pre

septv 1939] BRONCHIECTASIS : UKIL & DE 529

apparently peri-bronchial in distribution gave a history of cough, bouts of fever, lassitude, etc.

Mantoux reaction and clinical examination gave further grounds for suspecting tuberculosis and they were x-rayed.

I can recall several cases in each of which a

Skiagram taken at the onset of the illness showed bese appearances which were ignored and a few P^onths later dense circular deposits appeared 111 the same region. But mostly, this type

of

case is resistant with a tendency to localization fibrosis. Descriptions of similar appearances

fre given by Fishberg (1932) although he says he idea of peri-bronchial tuberculosis has been

abandoned at present'. Perhaps it is best to

?aH this tvpe ' early spreading granuloma following Wingfield (1937) and with him insist

the diagnosis of tuberculosis at this stage.

Table VIII

Showing percentage incidences of different _ lesions

U cases with cavities Cavities with hard fibrous A/r^l^ among the above .. iynd-zone lesions-?

In left lung In right lung

Present series

42.9

20.0

28.7 26.6

Dr. Benjamin's series (1938)

73.3

5.9

73.1 71.2

a ?r Purposes of the above table, the percent-

age has been calculated on the 840 active cases, - eluding the 160 cases in group A with no active disease. A sanatorium gets only selected cases referred

co t other doctors, and usually, in our

f llj !'y, only at a stage when the private doctor in+??

can tackle it no longer. It is hardly

Ind 0 conc^uc^e

' th&t the disease in

litt/f11 Pa^en^s ^ acute, rapidly developing with hp v tendency to show a natural resistance

and

Sam

' ?n a study ?t a defin^ely selected

Par ' ^le Present study based on an out-

lent population Of a tuberculosis institution

ta?WS that such an alarmist view need not be $er'en the type of the disease. Even this ?nlleVS' a^er a^> a selected group, and it is Se,y by the extensive random surveys of un- a

e,c ed groups together with the recognition of

sitf 6 ' tuberculosis minor' that the exact

soi u ?n Regarding the type of tuberculosis in

h India can be gauged.

the -pv.t'lanks are due to Dr. K. Vasudeva Rao, st ,^lrector, for permission to make

the above

Ma y at the Government Tuberculosis Institute,

^ , References

VolG1r'^^n' P- V. (1938). Indian Med. Gaz., FiiuXIII? P- 54?-

Vol y 5' M. (1932). Pulmonary Tuberculosis.

Lea and Febiger, Philadelphia. (Continued at foot of next column)

\

(Continued from -previous column)

Russell, A. J. H. (1938). Ann. Rep. Pub. Health Commissioner, Govt, oj India, 1936. Vol. I., Manager of Publications, Delhi.

Wingfield, R. C. (1937). Pulmonary Tuberculosis in. Practice. Edward Arnold and Co., London.