Changing Pattern in Causes of Death in Pulmonary Tuberculosis

¹ Chief, Laboratory Service
² Chief, Medical Service

During 11 years (1950-1960 inclusive) 295 necropsies were performed on patients who were treated for pulmonary tuberculosis. Significant changes were revealed in the cause of death and in the state of healing of pulmonary and extrapulmonary tuberculosis at the time of death.

Progressive tuberculosis was the leading cause of death in 1950, being listed as the principal cause in 74 per cent of cases. In 1959 and 1960, this was the cause of death in only 15 per cent of cases. Conditions related to tuberculosis, but not necessarily associated with active disease—pulmonary hemorrhage, pulmonary insufficiency, spontaneous pneumothorax, cardiac arrest during thoracic surgery, amyloid disease, chronic cor pulmonale — increased from 20 per cent in 1950 to 31 per cent in 1959 and 1960. Conditions unrelated to tuberculosis — carcinoma, myocardial infarction, cerebral hemorrhage, etc. — rose from 6 per cent to 64 per cent as cause of death.

In the early years of the study, the pulmonary tuberculosis was never healed on pathologic examination. The percentage of healed lesions increased steadily, reaching 35 per cent in 1959 and 1960.

Extrapulmonary tuberculosis, common in 1950, has been rare in the past few years. In the past five years, tuberculous ulcers were seen only five times, tuberculosis of bones once, and tuberculosis of the genitourinary tract six times. In addition to being uncommon, these lesions are usually of little consequence; for instance, all of the tuberculous entero-colitis in the past five years has been limited to a few isolated ulcers.

This review indicates that not only has the death rate in tuberculosis been greatly reduced by chemotherapy, but the character of the disease has been changed, and the cause of death altered. On chemotherapy, one-third of patients are found at necropsy to have healed tuberculosis and only 15 per cent of those who die succumb to progressive tuberculosis. Tuberculous patients who receive adequate treatment rarely die from tuberculosis. The most common causes of death among tubercubus patients now are unrelated nontuberculous disease.