Læknablaðið - 15.01.2005, Page 100

1 975-1 984 / BERKLAVEIKI
English summary
Because of signs of tuberculous lesions in old skeletons it can 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 descrip-
tions 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 registers the opinions is set forth that the disease has
been rare up to the latter part of the nineteenth century. During the two
last decades 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 started in the last decade of
the nineteenth century the reporting was first ordered by law with the
passage of the first tuberculosis Act in the year 1903. With this legisla-
tion official measures for tuberculosis control work really started in the
country. The first sanatorium was built in 1910. In 1921 the tuberculo-
sis 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 control work was begun and a
special physician appointed to direct it. From then on systematic surveys
were made, partly in health centers i.e. tuberculosis clinics, which were
established in the main towns, and partly by means of transportable X ray
units in outlying rural areas of the country. In 1939 the tuberculosis Act
was again revised with special reference to the surveys and the activities
of the tuberculosis clinics. This act is still 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 negative reactors were not X rayed. The tuberculin tests
were percutaneous, cutaneous and intracutaneous. The X ray examina-
tion duringthe first years was performed by means of fluoroscopy and
roentgenograms were made inall doubtful cases. In 1945 when the sur-
vey of the capital city of Reykjavik was made and comprised a total of
43,595 persons photoroentgenograms 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 attendance in these surveys
ranged from 89.3 percent to 100 percent of those considered able to
attend. In the capital city, Reykjavik, the attendance was 99.32 percent.
The course and prevalence of tuberculosis in lceland from 1911
to 1970 are traced on the basis of tuberculosis reporting registers,
mortality records which were ordered by law in 1911, tuberculin surveys
and post mortem examinations. The deficiences of these sources are
pointed out. Since 1939 the morbidity 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 tubercu-
losis 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 revi-
sion of the tuberculosis legislation and more exact reporting regulations.
After that year the fall is almost constant with rather small fluctuations
as regards new cases, relapses and total number of reported cases
remaining on register 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 noteworthy drop both in new cases and the total number reported,
doubtless because of the new specific medication 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 registration 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 temporary increase during the years of the second world war,
continued to fall rapidly reaching 20 per 100,000 population in 1950. In
the period from 1930-50 the tuberculous death rate thus dropped a little
over 90 percent.
In the year 1952, when specific tuberculosis medical treatment was
initiated (streptomycin, isoniazid and PAS) the death rate dropped to 14
per 100,000 population and the next year further down to 9 and since
1956 it never exceeded 5 per 100,000. From the year 1962 the tubercu-
losis mortality has never been over 2 per 100,000 population.
The mortality rates have been broken down to reveal the role of
age and sex specific death rates over some selected five year periods.
Also the rates are shown according to different forms of the disease,
pulmonary, meningeal and other forms. The highest proportionate
mortality (60%) was observed in the 15-19 year age group between
1926 and 1930. From 1911 to 1930 tuberculous meningitis caused a
remarkably high number of deaths, fluctuating between 20 and 50 per
100,000 population. Since 1956 not a single death from this form of the
disease has occurred. Up to that year the highest meningitis death-rate
consistently occurred in infancy and early childhood.
Sex-specific tuberculosis death rates indicate that in every age-
group the disease is more dangerous to women. Between 1941 and
1945, when the combined mortality-rate began to drop sharply, it was
the rate for the males, which was first affected.
Due to the very steep decline in tuberculosis mortality especially
from 1952 tuberculosis mortality figures can no longer be considered
the right criterion for the spread and course of the disease. The infection
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