A study was made of 2954 Pulmonary Tuberculosis patients who had been diagnosed
at the Severance Hospital, Chest Clinic from January 1st, 1954 to December 31st, 1956
in order to classify those patients in term of the duration of ambulatory treatment,
sputum status and x-ray changes at stated periods following admission.
In regard to the characteristics of the group studied it was found that 25% were
minimal 41% moderately advanced, 32% far advanced and 2% unknown, so that 73%
had extensive disease. The highest incidence(22%) was in the 21~25 age group, and the
lowest(1.4%) under 15 years of age. When the unemployed or unclassified were excluded
from calculation (about 50% of total number of patients), the highest percentages were
among students(24.3%) and service workers(servants, barbers waitresses etc.). Eighty
percent of the patients lived in Seoul and 20% in rural areas.
Among the 2,954 patients, 1,474(50%) dropped out in the first month, as they came to
the clinic for diagnosis only. Fourteen hundred and eighty(1480) patients who started
treatment and remained more than one month were classified as 273 in minimal, 663 in
moderately advanced, and 544 in far advanced. Each group was calculated on the rates
of the number remaining on record at the beginning of intervals of 6 months, 1 year, 2
years, and 3 years, respectively, as known in Table 5. Under the assumption that if
1,000 cases in each group had visited at one time and been discharged with the average
rate in each interval, the number of patients remaining on record on 6 months following
admission would be 648, 729 and 789 or a ratio of 1 : 1.1 : 1.2 minimal, moderate and
far advanced, respectively. At the end of the 1st year 378, 544, 590 or a ratio of 1 : 1.4
: 1.6: at the end of the 2nd year 174, 361 and 421 or 1 : 2.0 : 2.4 at the 3rd year 97,
297 and 347 or 1 : 3.0 : 3.5 This indicates that there is not much difference in the
proportion of each group remaining up to 1 year. but 3 years later, the numbers of
moderately or far advanced cases remaining in the clinic are 3 times more than of
minimal cases. Therefore, the chest clinic which has a large case load of such long term
ambulatory patients, most of whom are problem-cases clinically and epidemiologically.
On analysis of the sputum and x-ray findings patients treated with Anti-TB drugs
for such a long term gave some indication of the problem of chronicity as show on in
Tadle 6 and 7. In each group remaining after more than 9 months of ambulatory
chemotherpy, 25∼30% of minimal cases, 35∼45% of moderately advanced cases still had
positive sputum and more than 50% showed no x-ray improvement.
Such a group of chronic patients is not only a problem in the clinical sense, but also
is an important source of infection from is an important source of infection from the
viewpoint of public health. As shown Table (8), 14.4% of 757 contacts in 151 families of
the sputum positive index cases were found by the Seversance Chest Clinic, Mobile
x-ray unit as suspected cases of tuberculosis, while 3.47% of the general population was
active according to the National T.B. Center. Thus it is emphasized that in Korea
physicians who are working in the chest clinic with a heavy load of extensive disease
have not only a duty to prescribe proper medicine for such patients, but also must be
aware of their responsidility to give the patients instruction regarding preventive
measures, especially emphasizing that the members of their family must be brought for
routine health examination or medical surveillance in order to prevent the spread of T.B
from generation to generation as so often occurs where there is on case of T.B. in a
family.
|