Changing Patterns in Chest Disease: A Perspective of Two Decades

¹ Assistant Clinical Professor of Medicine, University of California School of Medicine
² Clinical Professor of Medicine, University of California School of Medicine, and Chief, Tuberculosis and Chest Service, San Francisco General Hospital

A total of 412 deaths occurring during three representative periods since 1942 on the Tuberculosis and Chest Service of a large municipal hospital were analyzed to portray changing mortality patterns in chest disease over the past two decades. Dominant mortality patterns observed prior to the discovery of streptomycin (1942-43), after streptomycin but before isoniazid (1950-51), and in the post-isoniazid period (1960-62) were compared.

In addition to corroborating the findings of others by showing a steady decline in the overall death rate, a detailed breakdown of principal causes of death was presented. Tuberculosis was the principal cause in 87.4 per cent of deaths in the year 1942-43 and in only 18.2 per cent of deaths in the period 1960-62. The distribution of tuberculous and nontuberculous causes of death showed little change from the years 1942-43 to 1950-51, suggesting only minimal effect of streptomycin on this parameter.

The mean age at time of death has steadily increased while the mean duration of terminal hospitalization has decreased.

A breakdown of deaths from tuberculous causes showed the virtual disappearance of extrapulmonary factors, except meningitis, which resulted in a small number of deaths in each of the periods studied.

See Table in the PDF File

Among nontuberculous causes of death, most prominent in the post-isoniazid period were carcinoma of the lung, other malignancies, cardiovascular disease and infectious chest disease.

The data were discussed in relation to community public health statistics and the historic development of effective antitubercubosis chemotherapy.

Changing trends have exposed chest physicians and chest hospitals to an everwidening array of nontuberculous disease. Implications of these trends as they relate to staffing and equipping a modern chest disease service were stressed.