Læknablaðið - 01.02.1976, Page 81

LÆKNABLAÐIÐ
45
ist að beita þessari varnaraðferð eða al-
mennri BCG-bólusetningu.
Að sjálfsögðu ber að miða allar berkla-
varnir þjóðarinnar við útrýmingu sjúk-
dómsins úr landinu. Framtíðin ein ber i
skauti sér, hvort slíkt tekst og þá hvenær.
Læknastétt landsins svo og allt heilbrigðis-
starfslið verður enn um langt skeið að vera
vel á verði gegn sjúkdómnum. Ákvæðum
laga og varnaraðferðum getur orðið að
breyta á margan hátt, áður en lokamark-
inu verður náð.
SUMMARY
SIGURÐUR SIGURÐSSON:
Tuberciúosis in Iceland
Because of signs of tuberculous lesions in
old skeletons it ean be stated with certainty
that tuberculosis has occurred in the country
shortly after the settlement.
From that time and up to the seventeenth
century, little or nothing is known about the
occurrence of the disease. A few preserved
descriptions of diseases and deaths indicate
that tuberculosis has existed in the country
before the advent of qualified physicians in
1760.
On the basis of papers and reports from the
first physicians and the first tuberculosis re-
gisters the opinion is set forth that the disease
has been rare up to the latter part of the
nineteenth century. During the two last de-
cades of that century the disease began to
spread more rapidly and increased steadily up
to the turn of the century.
Although reporting of the disease was start-
ed in the last decade of the nineteenth cen-
tury the reporting was first ordered by law
with the passage of the first tuberculosis Act
in the year 1903. With this legislation official
measures for tuberculosis control work really
started in the country. The first sanatorium
was built in 1910. In 1921 the tuberculosis Act
was revised and since then practically all the
expenses for the hospitalization and treatment
of tuberculous cases has been defrayed by the
state.
In the year 1935 organized tuberculosis con-
trol work was begun and a special physician
apnointed to direct it. From then on. sys-
tematic surveys were made, partly in health
centers i. e. tuberculosis clinics, which were
established in the main towns, and partly by
means of transportabie X ray units in outlying
ruróil areas of the country. In 1939 the tuber-
culosis Act was again revised with special re-
ference to the surveys and the activities of
the tuberculosis clinics. This act is stili in force.
Some items of it are described.
The procedure of the surveys and the
methods of examination are described. The
great majority of subjects were tuberculin
tested and all positive reactors X rayed.
Furthermore, X ray examination was made
in all cases where tuberculin examination had
not been made or was incomplete. The nega-
tive reactors were not X rayed. The tuber-
culin tests were percutaneous, cutaneous and
intracutaneous. The X ray examination during
the first years was performed by means of
fluoroscopy and roentgenograms were made in
all doubtful cases. In 1945 when the survey
of the capital city of Reykjavik was made and
comprised a total of 43595 persons photo-
roentgenograms were made. After 1948 only
this method together with tuberculin testing
was used in all the larger towns in the country.
During the period 1940-1945 such surveys were
carried out in 12 medical districts, or parts
thereof and included 58.837 persons or 47
percent of the entire population. The attend-
ance in these surveys ranged from 89,3 percent
to 100 percent of those considered able to
attend. In the capital city, Reykjavik, the
attenndance was 99.32 percent.
The course and prevalence of tuberculosis in
Iceland from 1911 to 1970 are traced on the
basis of tuberculosis reporting registers, mor-
lality records which were ordered by law in
1911, tuberculin surveys and post mortem exa-
minations. The deficiencies of these sources
are pointed out. Since 1939 the morbidily rates
are accurate. The number of reported cases
of tuberculosis increases steadily up to the
year 1935, when 1,6 percent of the population
is reported to have active tuberculosis at the
end of that year. Thereafter it begins to decline
gradually the first years but abruptly in 1939,
then without doubt because of the revision of
the tuberculosis legislation and more exact
reporting regulations. After that year the fall
is almost constant with rather small fluctua-
tions as regards new cases, relapses and total
number of reported cases remaining on re-
gister at the end of each year. In 1950 the
new cases are down to 1,6 per thousand and
at the end of the year the rate for those
remaining on register is 6,9 per thousand. In
the year 1954 there is a notworthy drop both
in new cases and the total number reported,
doubtless because of the new specific medi-
cation which began in 1952. In 1960 the new
cases are down to 0.4, relapses 0.2 and the
rate for those remaining on register at the
end of the year 2.4 per thousand. And in 1970
the rate for the same categories are: new 0.2
relapses 0,06, and remaining at the end of
the year 0,5 per thousand.
At the beginning of the period, when re-
gistration of deaths was initiated, tuberculosis
mortality was found to be about 150 per 100.000
population. During the next two decades it
increases, irregularly but persistently, to reach
a peak of 217 in 1925. It remained high for
the next seven years, dropped suddenly to
154 in 1933, and then, apart from a slight