Nýggir tilburðir við tuberklasjúkum í Eiðis læknadømi frá 1920 til 1952. II

Abstract

The present work is a continuation of an article in Fróiskaparrit VIII, 1959, and deals with the new cases of tubercular disease in joints and bones, subcutaneous glands, genital organs and bladder, skin and lungs, occurring in the Medical District of Eiði from 27. VI. 1920 to 26. VI. 1952. In addition reference is made to cases with fatal results and to nonstubercular diseases which often appear simultaneously with initial fever and are apparently due to toxins from the tubercular bacillus.

In the case of 14 children and adults (9 male, 5 female) tuberculosis occurred in Iimbs and bones. 3 of these became ill twice, the second ime the tuberculosis was in an entirely different bone. The total number of cases was thus 17 (11 m., 6 f.). Table 1 shows that these fall naturally into 2 groups: children under 15 years, in all 6 cases (4 children), and adults between 20 and 39 years, 10 cases involving 9 persons (8 m., 1 f.). Further the case of a woman over 60. There was no case between 15 and 19 years. This position is reversed in cases of initial fever, noted at the bottom of Table 1. It occurred more frequently during these years than at any other time.

There are two cases of tuberculosis of the joints: 1 child and 1 adult. In the case of the child spondylitis occurred 2 years 5 months after tuberculosis of the knee joint. This case is therefore given on Table 2 (No. 3), which deals with the cases of spondylitis, 8 in all, further the tubercular diseases which proceded and followed behind.

In 4 out of the 8 cases spondylitis arose within two years after the date of infection. The period was longer in the other cases, in the case of No. 9 at least 20 years. 1 of the 8 patients with spondylitis had only a single tubercular vertebra, all the others had two. In 6 cases the lumber vertebrae were affected and these only were tubercular.

Altogether 3 of the patients with bone tuberculosis died, 1 of pulmonary tuberculosis. Table 3 consists of a list of those bones and joints where the tuberculosis was situated. 

Altogether 19 (9 m., 10 f.) children and adults with tuberculosis of the subcutaneous glands. Their sex and age are given in Table 4. 14 had glandular swellings on the neck, in 4 cases swellings were in the elbow and armpits, and 1 case was diagnosed as adenitis subcutanea tuberculosa universal. It will be seen from Table 5 that 5 of the 15, all children aged 10 years or less and 2 others aged 15 and 21 years, developed their tubercular swellings within 2 years of infection. 6 showed an interval of 5 to 18 years from infection to illness, 1 took at least 9 years, another not less than 12 years between infection and illness, in 4 cases no details are available. In 3 of the 19 cases growth of the subcutaneous glands and the incidence of tubercular disease in the lungs and pleura occurred to some extent simultaneously.

In the case of 5 men and 1 woman the tuberculosis was situated in the genital organs. 4 of the 5 men had tuberculosis on both sides, only 1 case, the oldest of all, was on one side only. In none of the cases did both glands become affected at the same time, the interval being from 6 months to 2 years. The date of infection is not known in the case of the two oldest patients, aged 57 and 38; infection in the other 3 cases took place 4 years, 6 months and 4 months respect ively before illness. The last 2 also had tuberculosis in other organs as well. — The female patient died at the age of 20 of tub. peritoneie salpingitide. She was presumably infected by her mother in her earliest childhood.

5 cases of skin tuberculosis: 3 children, 10 to 14 years, with tuberculs ides, a man of 24 years with a well defined tubercular lump at the top of the outer side of the left thigh, and a woman of 55 years with lupus vulgaris. In the first 4 cases the tubercular disease appeared respectively 1 year, 6 years, 3 months and at least 5 years from the time of infection. No details are available for the 5th case. 

By pulmonary tuberculosis we here mean changes in the lungs which show themselves to be tubercular as a result of auscultation, percussion or occurrence of tubercular bacilli in smears. It will be seen from Table 6 that altogether 76 (38 m., 38 f.) new cases were noted in the period of 32 years, and that tubercular bacilli were found in the sputum of 64 of these (33 m., 31 f.). As Table 7 shows altogether 31 persons (12 m., 19 f.) died. In 25 of the 76 new cases the date of infection is known, see Table 8. No less than 18 (10 + 8), 72°/o of these 25, became ill in the 10 years from their 15th birthday to the end of the 24th year. The period between infection and the appearance of tuberculosis is seen from the table to be extremely variable, but all the indications suggest that these 10 years are particularly dangerous for those infected at such an age or earlier. In Table 9, graphs illustrate (I) cases of initial fever (106), (II) new cases of pulmonary tuberculosis (76), (III) deaths from this cause (37, see below). The initial fever begins 10 years before pulmonary tuberculosis, and this 5 years before the deaths' graph.

Graph I rises steeply and stops in the forties; graphs II and III continue to the eighties. During the period of 32 years there occurred 31 deaths of pulmonary tuberculosis among the 76 new cases noted in the Medical District of Eiði. If all the deaths which occurred in this period are to be included, we must add those cases where the disease began and was known before 27. VI. 1920 and who died after this day. These numbered 6 (3 m., 3 f.), giving a grand total of 37. As Table 11 shows, all told
47 deaths occurred from all forms of tuberculosis, which equals 6,6 per 10,000 for the whole medical district and 5,2 per 10,000 from pulmonary tuberculosis in the 32 years.

Tuberculosis is by no means equally distributed. In village M with 231 inhabitants there were 19 deaths from all forms of tuberculosis, of which 16 were pulmonary tuberculosis, which equals 25,8 and 21,6 deaths per 10,000 respectively. In village B with 247 inhabitants the corresponding numbers were 13,9 and 11,4. The parish with the highest population (629) and 8 and 6 deaths equals 4 and 3. Another parish with 436 inhabitants had only 1 death (menigitis) in these 32 years.

Erythema nodosum is not the only nonstubercular disease which is opserved together with or immediately after the initial fever. 5 others are here named angina, enlargement of the spieen, glomerulonephritis, phlebitis, myalgia and together with these arthroitis. These must be occasioned by the toxins of the tubercular bacillus. Not a few sufferers with initial fever have reddening in the throat. In 3 cases, all children, aged 4 months, 6 months and 7 years, the spleen was felt to be enlarged. 1 girl aged 17 had hæmorrh. nephritis; she died 6 months later of tub. pulm. A 19»year old girl and a 26*year old man passed through severe tubercular infections, lljl months after the onset of initial fever they were subject to serious phlebitis. The first died 5 months later of tub. pulm. caseosa, the other had to suffer a considerable number of tubercular diseases, including tub. pulm. ( + t b . ) , and spent over 3 years in sanatoria and hospitals before being certifitd as cured. An 185year old girl was afflicted with severe myalgia and arthritis; she died of tub. pulm. miliaris 4 months after the onset of initial fever.