Author's summary;
This study has been done to learn the yearly changes in the behavior of pulmonary
tuberculosis seen at a private out-patient clinic during last 15 years.
The clinical records of 4 groups representatively sampled at table I were analyzed
retrospectively and the results were presented with the percentages to show the trends
of the changes.
(1) The sex ratio of attending patients (Fig. 1)
The proportional rates of tuberculosis in each group of the 4 periods showed no
significant clanged but the female tuberculosis patients showed gradual increase to
31.10% Group Ⅳ from 21.9% in Group I
This was interpreted as a sign of the social advance of female population in recent
years rather than actual increase of the disease.
The result of the last 2 national tuberculosis survey also showed slight increase in the
relative ratio of the female patients from 37.3% in 1965 to 37.8% in 1970, but this
difference must be too small to such an influence. Also the same surveys showed a
rather constant sex ratio of less than 2 male to one female (j. e. the prevalence of 6.
4% to 3.8% in 1965 and 5. 1% to 3.1% in 1970), the sea ratios of those patients
attending this clinic were about 3 to 1 while the ratios of the total patients were about
2 to 1. This means that the female patients with the chronic disease like tuberculosis
attend the clinic with more difficulties than males.
(2) The proportion of active and inactive cases (fig.2)
The proportion of the female inactive cases were somewhat increased, 20.1% in the
Group I and 29.1% in the Group Ⅳ and the ratios of male and female in active cases as
well as inactive cases were reversed in the Group Ⅳ compared with the one in the
Group I This also could be thoutht as a sign of the progress of spacial position of the
females.
The overall ratio of the active and inactive cases attending this clinic showed no
continuous changes.
(3)The age and the sex distributions of the tube rculosis patients (Fig. 3) The peak
age group remains at the 25-34 years age zone as eyer in the both sexes but the
heights of the peaks were gradually lowered to 33.5% in the Group Ⅳ from 40.78% in
the Group I among the males and 43.24% in the Group Ⅳ frown 54.96% in the Group I
among the females.
On the contrary the old age groups showed gradual increase to 16.47% in the group Ⅳ
from 8.74% in Group I among the male and 9.46% in the Group Ⅳ from 2.29% in the
Group I among the females of the 45-54 years age group for example.
Those changes were slightly more marked among the males.
(4) The extent of the disease on admission(Fig.4)
The proportion of the minimal cases showed gradual increase, from 15.84% in the
Group I to 33.80% in the Group Ⅳ and accordingly the far advanced cases and the
moderately advanced cases showed some decrease. This could to interpreted as one of
the fruits of the public education for the tbureculosis diagnosis.
(5) The changeability classification and the proportion of initial treatment case (Fig.5)
The cases of initial treatment showed gradual increase to 41.7% in Group Ⅳ from
22.84% in Group Ⅰ.
This could be also a result of the public education in most part. However the easily
changeable cases ideal for chemotherapy was very small. This means that the provisions
for earlier diagnosis are much desired forever.
(6) The mode of onset (Fig. 6)
The author classified the mode of the onset of disease (or the incentives fort the first
diagnosis) in 4 categories, (1) gradual (2)hemoptic (3) pneumonic onset and (4) found by
mass X-ray, including X-rays taken on various occasions of physical examinations.
The cases found on the mass x-ray were gradually increased to17.81% in Group Ⅳ
from 8.66% in Group I and accordingly the cases of gradual onset decreased. The cases
with acute pneumonic onset and the cases with hemoptic onset showed very little
changes.
The policies of the advanced countries does not faver for the mass X-ray, but
according to above figures it was much worthwhile in the countries like Korea where
the tuberculosis are still prevalent.
(7) The duration of the disease on admission (Fig.7)
The numbers of the patients coming to this clinic within 6 months after the onset of
the disease (or initial diagnosis) increased gradually to 41.70% in Group Ⅳ from 22.84%
in Group I. This could be also taken as one of the encouraging signs brought by the
mass education of the tuberculosis control work.
However the numbers of the patient with 10 years or more durations remained almost
same.
This means that the percentages of the uncooperative or inconsistant patients are
almost constant and the problems of those chronic cases must be solved in the future.
(8) The sputum examination on admission (Fig.8)
It would be a common rule to order the sputum examinations for the diagnosis of
tuberculosis on admission and during the courses of the treatment by any physician. But
it had been frequently neglected by many patients.
The numbers of the patients who had no sputum examination were very large reaching
to 63.4% in Group Ⅰ, but since a special attention had been paid in recent years to get
more of the sputum examination, the rates were markedly downed to 13.26% in Group
Ⅳ. The policy in recent years at this clinic was asking to yield the specimen on the
spot in stead of asking to come back with the specimen 9n the neat visit.
If the patient asks an excuse because of no sputum to expectarate, then about 10m1 of
distilled water was injected into the patient's throat and have the patient to do deep
gargle for several seconds then spit into the sputum collector. Following this procedure
asked to cough several times and to spit any more sputa into the same collector.
The ratio between the positive and negative sputa among the examined were rather
similar, half and half throughout, although the numbers with the sputum examined
remarkably increased and accordingly the percentages at the patients with the sputum
positive increased to 46.36% in Group Ⅳ from 13. 26% in Group Ⅰ.
(9) The continuation of the treatment at this clinic (Fig. 9)
The long term treatment courses were frequeatly not carried out by the patients in
many clinics as a rule and there would be several important treasons to produce such
defaulters. Since this clinic is a private one the patients come and go freely. However
the treatment durations were moderately lengthed in recent years, ye fort example, the
patients who continued he treatment up to 18 months increased to 14.37% in Group Ⅳ
from 7.37% in Group I and the ones of up to 3 years increased to 18.8: % in Group Ⅳ
from 8. 84% in Group 1.
On the contrary the patients who visited this clinic only once or twice decreased
gradually.
Those phenomena also must be considered as one of the results of the public educatior
as well as a certain improvement of physician-patient relationship.
(10) The X-ray changes after the treatment of more than 6 months at this clinic (Fig.
10)
There were gradual increase of the improvement rates in the results of the treatment,
but the degrees were rather small to compare with the marked increase of additional
adminstration of the newer (secondary drugs) in recent years shown as in Table 2. The
percentage of af administration of newer drugs reached to 32.93% for even the minimal
cases, 59.83% for the moderately advanced cases, and 69.89% for the far advanced cases
in the Group Ⅳ while none at all in the Group Ⅰ. The indications of the primary drugs
also showed much difference among those groups, for the minimal cases and 39.13% for
the moderately advanced cases in the Group I but it was 47.31% and 65.81%
respectively in the Group Ⅳ.
(11) The sputum conversion rates
Because of the numbers of the sputum examined patients in the Group I and Ⅱ were
very small, a direct comparison of the sputum conversion rates with the one in the
Groups Ⅲ and Ⅳ would be not justifiable. However sputum conversion r aloes showed
a gradual increase to 66.6% in the Group Ⅳ from 52.63% in the Group Ⅰ.
These improvement toward recent years should be considered as the effects of the ever
improving chemotherapeutics. But the degree of the improvement in the sputum
conversion was not very satisfactory in general when considering the large amount of
the drugs we added to the previous regimens.
Conclusion;
There would be several ways to evaluate the results of tuberculosis control work and
the effectiveness of the new chemothemotherapy.
The author intended to see the results rather indirectly and the changes occurred
during last 15 years among the patients attending a private clinic seemed to be vague
or complicated to appreciate.
In conclusion, however, it could be said that there were several changes in the clinical
behavior of to berculosis revealed among the patients attending the clinic during last 15
years.
Those changes were possibly bronght in by the tuberculosis control works of the
country as well as the new drugs added to the previous standard primary drug
regimens, but the changes were slow and small.
It is the anuthor's opinion that there must be some additional measures beside
up-to-present tuberculosis control policies to provide more convenient ways for early
diagnosis and better means for regular treatment for the patients.
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