Tuberculosis of the upper air passages and ears

Abstract

DURING the past forty years the mortality from tuberculosis has fallen consistently and this downward progress was only slightly interrupted by tile two world wars. The annual number of deaths now is only a third of the I9I 3 figures. The total number of cases of tuberculosis reported has not undergone the same reduction, but the morbidity is greatly diminished. Morbidity figures include tuberculous lesions of the larynx, pharynx, mouth and ears. Forty years ago between ~o and 3o per cent. of all tuberculous patients developed tuberculous lesions in the larynx and perhaps I per cent. developed lesions in the pharynx, the mouth or the ears. Today the laryngeal lesions occur onlyin 23 per cent. of cases and the other lesions are now only occasionally seen. It is not easy to point to any one particular reason for this reduction, for there are probably a number of contributory factors. There may have been a change in the virulence of the causative organism. Such fluctuation is known in other bacterial diseases--scarlet fever and measles being two examples. These changes may be brought about by persistent and partly successful treatment when bacteria are being bred from strains whose virulence has been diminished by such :treatment. Possibly, the virulence of the organism has not changed, but a nation-wide resistance has developed; a resistance that is shared by many of the more highly developed nations but not by the undeveloped ones. This resistance may be at least in part due to the improved standard of living and nutrition during the period under review: Working hours and conditions have improved, but for much of the population there is still gross overcrowding in old and insanitary buildings, and this factor is responsible for the high level of new cases of tuberculosis. Other factors that have helped in the reduction of both mortality and morbidity are earlier diagnosis and more efficient care and treatment. The introduction of tuberculosis dispensaries and chest clinics and the appointment of special tuberculosis medical officers have played a great part in the new developments. Mass radiography has also helped to discover early cases at a treatable stage. Apart from artificial pneumothorax no real improvement was introduced in the treatment of phthisis until the advent of plastic operations on the thoracic cage and paralysis of the diaphragm in the third decade of the century. The introduction by Waksman in 1944 of streptomycin was one of the most notable advances in the treatment of tuberculosis and has had a Profound