A Survey of Pulmonary Tuberculosis in the Outer Hebrides

Weir, Robert M. L (1953) A Survey of Pulmonary Tuberculosis in the Outer Hebrides. PhD thesis, University of Glasgow.

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The soci-economic evolution of the Outer Hebrides shows that the inhabitants have lead an isolated existence since the Viking invasions. As far as tuberculosis is concerned there is no mention of it appearing in these islands up to about 1850 A.D. and thereafter it assumed a disease of major proportions. The first cases of tuberculosis arriving here were patients who contracted the disease in the mainland cities and because of an absent inherent resistance and the poor hygenic circumstances of the homes, tuberculosis soon assumed epidemic proportions affecting whole families. The present finding is still that a high proportion of cases develop in Hebrideans who leave the Islands to work in the cities. The statistics of Tuberculosis in the Outer Isles is discussed and these show a high notification rate with the age incidence of the two sexes being similar. The death rate from tuberculosis is high but is diminishing. Percentage infection rates suggest that in the rural parts the majority of children leaving school are Mantoux negative. A survey of the unrevised notified register in 1951 was carried out and of the 537 patients notified as suffering from pulmonary tuberculosis an evaluation of the extent and type of the disease was made. It was found that males predominate 58% - 42% (females). A review of the lesions grouped according to initial extent and showing the further course and treatment provides the material on which the form of tuberculosis in this locality is given. 68 patients showing extension of the disease visible radiologically are discussed and the commonest age at which this occurs is between 15 - 35 years with a predominance of females under 25 years and of males above that age. The spread of the disease is noted to occur as frequently as 2 years and over from the date of notification as before that period. The predominant form of the extension is a bronchogenic spread and the indications are that the disease conforms to the expected trend for Western Europe. 60 cases of minimal extent and probable activity show that the progression rate of the is land-treated case is no higher than that of similar white population reviews. The results of 108 A.P.s show that only 13 appeared uncomplicated and that just over 50% could not be continued for 2 years. The success of pneumothorax in relationship to the extent of the initial disease is discussed and the results show it to be unfavourable in disease of more than two zones. 88 patients have received treatment in the form of phrenic nerve crush and pneumoperitoneum of these 47% did not benefit from the therapy and improvement was most marked in lesions limited to two zones and less. The similarity in the evolution of tuberculosis locally with that observed in isolated districts of Norway and Sweden is examined and the decrease noted after four or five generations in Sweden leads to the expectation that tuberculosis in the Outer Hebrides should now be on the wane. B.G.G. as a measure to diminish the incidence of tuberculosis in young adults is considered and an extension of its use recommended together with further measures calculated to reduce the disease incidence rates.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Medicine, Epidemiology
Date of Award: 1953
Depositing User: Enlighten Team
Unique ID: glathesis:1953-78948
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 28 Feb 2020 12:09
Last Modified: 28 Feb 2020 12:09
URI: https://theses.gla.ac.uk/id/eprint/78948

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