Nýggir tilburðir við tuberklasjúkum i Eiðis læknadømi frá 1920 til 1952
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Abstract
The present work collects the fresh cases of initial fever, meningitis tub., tub. universalis, tub. miliaris peritonei, pericarditis caseosa prosductiva tub. and pleuritis exs. tub. in the medical district of Eiði, Faroes, in the period from 27/6 1920 to 26/6 1952.
By initial fever is here understood the febrile condition which often, but not always, sets in in connection with tuberculosis infection, and almost simultaneously with the conversion of the organism from anergy to allergy. It appears from Table 1 that, in all, in that period were known 106 cases of initial fever: cf 57, 2 49.
When the conversion takes place, it sometimes happens that the newly infected person does not feel it at all. Such quite nonsfebrile conditions are not included here. For that purpose a certain temperas ture is required — short or long, low or high.
Table 1 includes 47 children and 59 adults. As to the former, the infection sources are known: 20 were infected in their homes, and 23 in neighbouring houses — most of the latter by people whose tuberculosis had not yet been discovered. 4 children were infected while staying in other villages.
Of the adults, 13 were infected in their homes, and just as many in the neighbourhood or the circle of friends. In all these cases the infection sources are known. The others were infected during their work in other villages or towns, and in fishing vessels. In these cases the infection sources are not always known.
A man of 21 vvas infected with tuberculosis through a wound in his left fórefinger. Lymfangitis supervened, abscesses on the inside of the supper arm and in armpits. A girl of 8 was infected through her tonsils. The infection was followed by a glandular tumour on the neck.
Many of the newly infected complained of retrosternal pain in connection with swallowings, to both sides of the sternum, or pain round one or several of the thoracic vertebrae. Others talked of stitches, which were localized to different places of the chest.
In some cases the fever lasted for one day only or so, in others for rather a long time. Thus a 6 years old boy had initial fever for 7 months. X=ray examination at the beginning of the disease and 3 months later showed an increased shadow in the right hilus, otherwise nothing abnormal. 1 month after this were found a perihilar infiltration round the right hilus and a 3 cm broad paratracheal shadow up towards the clavicula. When further 3 months had passed, the infiltration had decreased, and only an enlarged right hilus was to be seen. Febrile and subfebrile all the time. — The duration of the initial fever seems generally to be 2—6 weeks.
In some cases the thermometer may show a subfebrile condition, in others a temperature of 40° C, and in one case 41° C as shown in Fig. 1. Adults and adolescents have a slow pulse during about the first half of the febrile period, which is also to be seen in Fig. 1. As will appear from Table 1, 27, or 25°/o, of the 106 cases with initial fever had erytema nodosum. Only 4, or 7°/o, of these were males, all of them under 15. 23, or 47°/o, were of females.
When the inítial fever sets in, rather often a mild and brief tonsillitis is to be seen. Occasionally there may be a brief hoarseness and a little hacking cough, which may be dry or attended by a sparse sputum. On rare occasions larger quantities are coughed up — up to 40 cra3 a day.
Sometimes stray wheezy sounds or rales are heard, fine crepitation or friction sounds over a more or less wide area. The initial fever may be initiated with diarrhea, 2 boys, both under 1, had an enlarged spleen. A boy of 6 had a stiffness of the neck and Kernig's Symptom without meningítis.
4 cases of meningitis tubercul. are known. In 2 of these, c? 9 years and 9 19 years, initial fever and meningitis passed gradually into each other and led to death 4—5 weeks after the first day of the disease. A boy of 1 died of tub. miliaris, and a man of 42 was for some time ill with tub. miliaris peritonei.
There were 106 cases of initial fever. Of these, 20°/o got pleuritis exs. tub., the children's percentage was 17, that of the adults, 22 (Table 2). Pleurisy cases in all: 73 (Table 3) - 59°/o right.sided, 41 °/o leffcsided. In Table 4, initial fever and pleurisy are compared. The former culminates at the ages of 15—19, the latter has its greatest incis dence between the ages of 20 and 29.
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