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pressure13*. To produce pulmonary hypertension,
its vascular network must be grossly reduced11.
Pulmonary vasconstriction can also occur if the
bronchial passages are blocked causing alveolar
hypoventilation15. If the bronchial passage is
restored, ventilation improves and pulmonary vas
cular pressure is restored to normal.
Symptoms are insidious at onset and the disease
takes a long protracted course. Initial manifesta
tions are often overlooked and are considered to
be due to pulmonary tuberculosis itself. So, an
early diagnosis of tuberculosis and institution of
proper, regular and adequate treatment help to
stave off the development of cor pulmonale. In
many cases, development of cor pulmonale is
noticed when features of congestive heart failure
become apparent. Patients, observed in hospitals,
represent only a preselected group and many of
them are from lower economic level of the society.
Those who can afford prefer treatment at home or
in nursing homes. Thus, quite a number of cor
pulmonale cases today go unnoticed and so
tuberculosis remains as a relatively uncommon
cause of chronic cor pulmonale. We have reasons
to believe that cor pulmonale, following tuber
culosis, is not uncommon. Moreover, due to potent
chemotherapeutic drugs, a significant portion of
residual deaths after tuberculosis are due to cor
pulmonale, even when tuberculosis itself has been
arrested3.
As tuberculosis is still the most prevalent chronic
respiratory malady in India, the incidence of chronic
cor pulmonale as an after effect of tuberculosis
is not likely to be so low. With high prevalence of
lung tuberculosis among poverty striken people,
with inadequate medical facilities and incomplete
treatment, number of cor pulmonale cases are
likely to be more. Hence, a long term study, using
a standard parameter of serial lung function test,
at least in hospitalised pulmonary tuberculosis
cases, may reveal more probable cases of cor pul
monale in future5. Further, investigation by clinical
examination, x-ray, ECG, blood gas studies and
follow-up of these cases may provide us with a
more accurate answer of incidence of the disease.
Tuberculosis in India—A Perspective !
D. R. NAGPAUL*
Although tuberculosis is known to have existed in India'!
from time immemorial, not much is known about how it was?
distributed, its spread, and the disease trend till lately. Much
of the information in the Vedas and Ayurvedic Samhitas deals
with the prominent clinical features of the disease and the )
kind of patients who might respond to certain treatment, i
Neither notification nor health statistics existed then, that •
could have thrown light on the rise and fall of the disease in ?
the country. The information that has become available over •
the last few decades, excepting properly conducted epidemio
logical surveys, also is not very reliable. Therefore, conflicting
claims are often made about the disease being on the increase,
endemic or declining in the country with no means available
to confirm the claimTUBERCULOSIS EPIDEMICS I
Like acute infectious diseases, the chronic infectious diseases I
also spread in communities as epidemics. But, the charac- !
teristic secular curve of these epidemics is not easily discernible. ;
Complete information about a tuberculosis epidemic is not s
available in any country of the world. In some European |
countries notifications of tuberculosis deaths became a regular i
practice from late 18th century and the mortality curves drawn I
on this basis suggest that a tuberculosis epidemic may last from j
200 to 400 years (Grigg, 1958). If so, the doubt arises whether '
ancient countries with thousands years of tuberculosis expe
rience have had one or several tuberculosis ep demies. In
view of paucity of information, some degree of conjecturing
may be permissible on the basis of the known facts.
For projecting a proper conjecture one must also draw |
upon the accepted typical features of the disease during the I
ascending and descending phases of the epidemic. During
spread of the disease in “virgn soil”, the infection, disease
and death rates are all high and there is little difference between
them^ the dsease is acute, rapidly progressive and often fatal,
and is concentrated among the young as well as the city dwellers
who live under conditions favouring dissemination. Spread
to rural areas occurs much later, but; in a very similar manner.
During the descending or waning phases, however, the above
mentioned rates are not only comparatively low but very
different from each other. The disease now is chronic, slow
or indolent, fibrotic, not so fatal and concentrated among the
elderly. During the endemic phase, all the features of the
waning phase prevail but, barring the temporary fluctuations,
there is little or no change in the various rates over long periods.
Grigg (Joe- cit.") also made several other significant obser
vations about tuberculosis epidemics, based on theoretically
drawn epidemic curves supported by many a piecemeal obser
vation from several different countries. Thus, the tuberculosis
epidemic curves of different countries or the different regions
Manish Ch. Pradhan
13Denolin, H.— Verhj Deutsch Ges Kreislaufforsch, 21:217,
1955, quoted by- 10McMichael, John.
"Bolt, W.,Forssmann, W. and Rink, H—Selektive Lungenaugiographie, 1957, Stuttgarh, quoted by 10McMichael,
John.
"Rossier, P. H., Buhlmann, A. and Wiesinger, K—
Physiologic Und pathophysiologic der atmung, 1956, SpringerVerlag, Berlin, quoted by 10McMichael, John.
---------------------------
National Tuberculosis Institute, Bangalore
, *B.Sc., M.B.B.S., T.D.D., Director
44
\
CURRENT TOPIC
* e country may appear to be different (but arc not
different) due to trying socio-economic environment
-ultant host-parasite relationship. Similarly, the peaks
^roulosis infection, morbidity and mortality may occur
° d^ff’rent times and to different extents in a country for
*"ff*rent agg’ seX an^ clbnic groups. In other words, to
k 3 tuberculosis epidemic in its true perspective, a broad
spread over as long a period as possible is necessary,
t^xiusc the statistics of a decade or two, collected from different
•0QS and selected consciously or unconsciously for diffrent
reasons, may more often mislead than tell the true position.
rUB£RCULOSIS IN INDIA :
. With regard to India, no direct evidence is available as to
ibc number of epidemics that the country has had so far, nor
is the true position on the current tuberculosis epidemic curve
known.
The most prominent findings of the National Tuberculosis
Survey (ICMR, 1959), Tuberculosis Prevalence Survey in
Tumkur (Raj Narain et al., 1963) and Tuberculosis in a Rural
population of South India, a five-year Epidemiological Study
(National Tuberculosis Institute, 1974) are that (i) the tuber
culosis morbidity in India is largely confined to older age
groups, (ii) prevalence in the rural areas is similar to that in
cities and (iii) the gap between infection and disease rates
(38 per cent and 0.4 per cent respectively) is very larger indeed.
All the 3 features satisfy the already mentioned charactcistics
of the declining and or endemic phases of the epidemic. Being
a scientifically collected epidemiological informational should
reliably mean that the epidemic is waning or has become
endemic.
The tuberculosis mortality information for India being
deficient and not very reliable still apprears to suggest that the
disease since the turn of the century has followed the same
general trend as in some western countries endowed with the
requisite notification data. Rogers (cited by Lankastcr, 1920)
at the time of World War I had estimated on the basis of post
mortem findings spread over 22 years that 17 per cent of the
total deaths in hospitals were due to tuberculosis. The decen
nial estimate of crude mortality during the 1911-21 census
period in India was 47 per mille. And, on that basis, the com
puted tuberculosis mortality would be 800 per 100,000 persons,
ifhospital deaths were truly representative of the general deaths.
Lankaster (Joe. cit.), after taking note of Roger’s estimate of
tuberculosis mortality, also quoted the other available statis
tics: Calcutta 2.1,Bombay 2.8,Madras 2.5 and Ahmedabad 5-9
per mille, and felt that the actual tuberculosis mortality would
be 4 per mille or higher in most of the Indian cities. But, that
was just about the position in Czechoslovakia (Radkovsky,
1959) around 1880 i.e., 40 years earlier. In any case, this is
the earliest available rough estimate of tuberculosis mortality
m India. McDougal’s (1949) estimate of the specific mortality
around 1949, however, was 200 per 100,000 persons whereas
that of Frimodt-Moller for the same year for the Madanapalle
towh“and surrounding area was 253 per 100,000 (FrimodtMoller, I960). Frimodt-Moller further reported that the
niortality in his study area was reduced to 64j_bct ween 1951-53
and 2l.j between 1954-55 per 100,000 persons, which he could
not explain except due to a natural decline plus the rigorous
antituberculosis measures introduced by him in the study area.
In ttje Bangalore district, not far from the Madanapalle study
area, in the longitudinal cpidemological study done under
conditions with no antitubcrculosis measures at all being
implemented, the estimated tuberculosis mortality during
1961-68 has been 100 per 100,000 persons (National Tuber
culosis Institute, loc. cit.)
It is realised that the quality of the above given mortality
statistics for India is very different and there must be some
regional variations as well. Nonetheless, the estimates if
plotted along a curve depicting the declining mortality in
Czechoslovakia since 1880 will show striking similarity of the
general trends (Radkovsky, loc. cit-)- In other words, the tuber
culosis epidemic in India perhaps has been following the same
course, some 30 to 40 years behind, as in Czechoslovakia at
least till 1950, when the era of potent antitubcrculosis drugs
began. Before coming to such a conclusion it would be wise
to guard against the possibility that the fall in tuberculosis
mortality was not largely or entirely due to a fall in the general
mortality. Ina way generally similar to that in Czechoslovakia
(Radkovsky, loc. cit.), the crude mortality in India also came
down from 47 per mille in 1911-21 to 15 per mille in 1971,
but the fall in tuberculosis mortality has becn.Slecpcii._c_.- falling
from about 17 per cent contribuiton to the general mortality
in 1920_to about 5 per ccni_pnw,.comparing fayourably. wiTh
that of Czechoslovakia namely from 15 per cent contribution
in 1900 to around 3 per cent in 1957.
In the opinion of many experienced^ clinicians in this
country tuberculosis has undergone a considerable change in
its clinical presentation, especially over the last quarter of a
century. Many retrospective studies (Tuberculosis Associa
tion of India, 1958,n^6B)TIcsprfct'hciFscicntific wealmess have
clearly brought out the gradual change from a comparatively
moreacute and extensive disease among the young to a more
chronic, less extensive disease among the elderly. The near
consensus of these reports has been on a marked decrease of
the concomitant complications of pulmonary tuberculosis/c.g.,
enteritis, laryngitis, amyloid disease, matted lymph glands with
discharg.ing_sinus.es, .etc._ IF is significant that very similar
changes were noticed in countries where tuberculosis has
definitely declined. The evidence in India, therefore, cannot
be brushed aside as unreliable.
I
Jt has been contended that the available direct epidemiological
information merely signifies no change in the prevalence of
bacillarytuberculosis in the country, at least for about 2 deca
des (Table 1). And, that equal prevalence in urban and rural
areas merely means that we are trujyjn the endemic-phased
the_djsease. It has also been argued that such a conclusion
would be in keeping with the long chequered history of India
where empires rose and, fell like nine pins leading to wide and
repcat.cd-disper salo f-th e-populati on_and.a.go od mi xi ngofrura 1
and urban people-fTuberculosis Association of India, 1968).
It could be argued with equal force that poverty, malnutrition.
and congested living, that have been with us for long, would
hardly favour the occurrence of conspicuous epidemiological
,changes over 2 or 3 decades. And, that long range indirect
evidence in a chronic disease like tuberculosis cannot have
less validity than the direct but short range epidemiological
findings.
Some direct evidence in favour of a declining trend, however,
has lately become available from the longitudinal cpidemioDECLINE OF ENDEMICITY:
•16
J. INDIAN M. A., VOL. 71, NO. 2, JULY 16, 1978
Table 1—Showing Prevalence of Tuberculosis per 1000 in
Various Epidemiological Surveys in India
Type of
disease
Bacillary
Active
abacillary
Inactive
abacillary
Inactive
insignificant
Survey p e r i c>d
National MadanDelhi Tumkur Bangasurvey
apallc
survey
survey
lore
1955-58 survey
1962
1960-61 survey
(ICMR, 1950-55 (Pamra,
1961-68
(Raj
1959) (Frimodt- 1966)
Narain (NationMoller,
et al.,
al Tub1960)
1963) erculosis
Institute,
1974)
4.0
4.1
18.0
4.0
4.1
4.1
13.2
14.9
—
—
—
—
_
10.6
—
27.5
—
9.1
logical surveys. In Table 2, the Bangalore study (National
Tuberculosis Institute, loc. cit.) is representative of the natural
time-trend of tuberculosis in a rural area whereas the Delhi
study (Pamra et al., 1968) gives the position in a slum popu
lation served by the New Delhi TB Centre providing treatment
to the diagnosed patients of the area. In both the studies
migration could have interfered with the findings, but the more
conspicuous and impressive effect of drought in the former
study suggests that migration may not have interfered much.
Of course, the observed decline in the already quoted Madanapallelongitudinal survey (Frimodt-Moller,loc. cit.) wasascribed
to the applied rigorous community control measures. Signi
ficantly, the decline observed in the infection as well as disease
rates in the Madanapallc rural TB control area and the Bangalore natural rime-trend rural area occurred first in the younger
age groups, as was to be expected. It would, therefore, be
reasonable to infer that there is a gradual but slow natural
Table 2—Showing Longitudinal Studies of Prevalence oi?
Pulmonary Tuberculosis in the Delhi and
Bangalore Areas
Delhi area
Prevalence per millc of
Sputum positive
Abacillary
Total cases
cases
active cases
4.0
4.0
4.0
1962
1964
1967
Bangalore
area
1961-63
1962-64
•1964-66
1966-68
17.2
12.9
13.7
13.2
8.9
9-7
Prevalence per mille of sputum positive cases
in age group (year)
5-14
15-34
35-54
>55
All
0.94
0.72
0.36
0.37
3.77
3.59
3.04
2.58
6.16
[75.25
6.04
7.56
11.46
12.08
10.10
12.19
4.06
3.72
3.37
3.93
decline of tuberculosis in live country. That morbidity
easily disturbed by adverse conditions like severe malnutrir*
drought, etc., may inadvertently lead to the impression if
tuberculosis is on the increase in the country or an aiu-»
Apart from anything else, the “no change in prcva]enc
argument favouring cndemicity is not helped by the sizeal
and rapid turn-over observed in the composition of prcvalen
cases. Fifteen villages constituting a part of the sample
NationalTubcrculosis Survey, wereresurveyed by thcNatior
Tuberculosis Institute after 5 years of the first survey (p
. Narain et al., 1962). The prevalence rates of radiology
disease were 1.7 per cent and 1.8 per cent and of sputum positi
cases 0.36 per cent and 0.46 per cent respectively in the 2 surve
But, of the 26 bacillary cases of the 1st survey, 14 had di«
4 could not be contacted, 6 had either become sputum negati
or become x-ray normal/inactivc and only 2 had maintain
the status quo at the lime of the subsequent survey. The fre:
cases of the 2nd survey had come most ly from the x-ray norma
and some from x-ray abnormals of the 1 st survey. Similar w,
the experience from the longitudinal epidemiological study
the Bangalore area. In other words, the considerable inc
dence of fresh disease is being marked by the sizeable sei
healing and deaths while in the endemic phase one wou
expect low prevalence and incidence rates.
The available evidence strongly suggests that India aircat
has had more than one tuberculosis epidemics. At present w
are somewhere on the descending limb of |the latest cpidemii
Grigg (loc. cit.) believes that the latest tuberculosis epidcml
in England began in the 16lh century and in Europe a hunden
years later. As in Eastern Europe, the latest tubcrculcs
epidemic in India may also have begun in the 17th centur
The very slow or nil rate of decline is perhaps due to the gene
rally unfavourable environment with personal privations an
or droughts causing temporary fluctuations in the seeming!
stable prevalence.
role of tuberculosis control programmes:
Can such a slow decline in the epidemic be hastened b
tuberculosis control programmes?
^^Environment is a fundamental factor in the ecological tria
of tuberculosis: Socio-economic conditions can alter the ep
demiological-.situatio.n_powerfully, for good or bad, over
decade or two. Since BCG vaccination has no influence o.
the naturally infected population and chemotherapy mere!
eliminates some cases_but_cannot prevent cases from occurring
a tuberculosis contrnLpmgramme has a low potentiaL.fo
influencing the epidemic curve, over a short period- So fai
"no_repprted__study, has successfully demonstrated the prim1
influence .of_antituberculosis programmes in controlling th
disease, without a concomitant marked improvement in th
standard of living of the people. But, control programme
certairfly help.
Under the National Tuberculosis Programme, infectiou
cases of tuberculosis are being diagnosed at a comparative]?late stage. They, presumably, would already have done a
major part of the damage (spread of infection) that they ar
capable of doing. Moreover, a sufficiently large number of
infectious cases (especially in the rural areas) has not so fai
come_u nd er .effective chemotherapy, as has happened in some
other countries or under study conditions. In the^Madan
apalle_study_area-(Er-imodt-Moller^_Z&Ci_cfL) with contro.
CURRENT TOPIC
47
Sowing Estimated Sputum Positive Cascs in Average Indian District with and without District Tuberculosis
PROGRAMME AT THE END OF ONE YEAR
Fate of prevalence cases during one year
No. of cases
at t0
(prevalence)
Dead
(sputum
negative)
Cured
(sputum
negative)
Remaining
(sputum
positive)
■^h^Tprosrarnnic (natural
time-trend)
5.000
700
1,000
3,300
With programme :
Not diagnosed
J,224
590
845
2,789
776
5.000
147
737
357
1,202
Diagnosed
Total
ipisures applied vigorously it was .after. 2 decades that morjj^fity was reduced to less than half. - The bacillus also possesses
the power of mutation and under ineffective chemotherapy
develops resistance—to drugs quickly. Therefore, 2 crucial
factors are needed before chemotherapy under the programme
could help reduce tuberculosis: A significant number oCinfectinns patients brought Amder_cffccLiYe_chemotherapy and a
couple of decades, if not more, of efficient .effoxt• BCG
vaccination to be really useful must (i) be given correctly and
(ii) constantly cover a significant proprotion of the suscept iblcs
in the community. These requirements are difficult but not
impossible to meet.
It is only about a decade since our National Tuberculosis
Programme has been in operation, but not so effectively. With
the data available on the natural time-trend of tuberculosis
and the operational studY_CI3ail\i.J.9Tl) of the average achieve
ments under the programme, a simple estimate of the expected
contribution to control of tuberculosis has been prepared
(Table 3).
Of the average 776 truly sputum positive cases, including
drug sensitive and resitant cases, diagnosed and put on treat
ment in one year in an average district under the programme,
147 would probably be dead (in spite of treatment). 357 would
become sputum negative—after applying differential cure rates
for the sensitive and resistant cases, and 272 would continue
to be sputum postiive after one year of chemotherapy. With
regard to the 4,224 undiagnosed cases in the community, the
death, cure and status quo rates would be the same as in the
uppermost row, as if there was no programme. This would
mean that 239 cases would be less in the community after one
year under the present efficiency of the programme. This
rough calculation without the other epidemiological “flows”
means a 4.8 per cent annual decrease, over and above the
natural decline, which need not be scoffed at. A corollary
would be that dividends would be more if case-findings were
to be improved in the programme, rather. than treatment
results from the, present 46 per cent sputum conversion at the
end of one year to say 80 or 90 per cent.
Summary
There are reasons to believe that India has had more than
one epidemic of tuberculosis since the time of yore. The
Cases added
(incidence)
No. of cases
at tx
(prevalence)
1,700
5,000
1,700
4,761
272 J
3,061
present epidemic might have started in the 17th century. There
is evidence that the present epidemic has been declining since
the turn of the 20th century. The natural decline at present
is very slow, probably because of the prevailing poverty,
malnutrition and over crowding. The District Tuberculosis
Programme, even at the present level of efficiency^ has a potem
ti.a£of accelerating the natural decline. Improved programme
efficiency, especially under case-finding, is likely to produce a
quicker decline. Rapid socio-economic development and
improved standard of living could lead to a more spectacular
decline in tuberculosis, but that effort would not strictly fall
within the purview of a specific control programme.
References
Baily, G. V. J.—An Operational Model of District Tuber
culosis Programmes, Paper Presented at the 1CMR Sym
posium on Tuberculosis, Madras, 1972.
Frimodt-Moller, J—Bull. WHO. 11.'. 61, I960.
Grigg. E. N. R.—Amer. Rev. Tuberc.. 78: 151. 1968.
ICMR—Tuberculosis in India : A National Sample Survey,
1959, Indian Council of Medical Research; Special Report
Series. 34.
Lankaster, A.—Tuberculosis in India, 19-0, Butterworths,
Calcutta.
McDougal, J. B.—Tuberculosis Global Study in Social
Pathology, 1949, Williams & Wilkins, Baltimore.
National Tuberculosis Institute—Bull.WHO, 51: 473, 1974.
Pamra. S. P., Goyal, S. S. and Mathur, G. P—Proceedings
of the XX1II Tuberculosis and Chest Diseases Workers’
Conference, Bombay, 1968, Tuberculosis Association of
India, New Delhi, p. 61.
Pamra, S. P.—Proceedings of the XXI Tuberculosis and Chest'
Diseases Workers’ Conference, Calcutta, 1966, Tuberculosis
Association of India, New Delhi, p. 91.
Radkovsky, J—The Share of Tuberculosis in Total Mortality
in Czechoslovakia, 1888-1957, Working Paper, Inter
national Population Conference, 1959, Vienna.
Raj Narain, Geser, A., Jambunathan, M. V- and Subramaniam, M.—Indian J. Tuberc-, 10: 85, 1963.
Raj Narain, Jambunathan, M. V- and Subramaniam, M.—
Proceedings of XVIII Tuberculosis and Chest Diseases
Workers’ Conference, Bangalore, 1962, Tuberculosis
Association of India, New Delhi, p. 34.
4S
J. INDIAN M. A., VOL. 71, NO. 2, JULY 16, 1978
Tuberculosis Association of India—Changes in the Clinical
Manifestation of Pulmonary Tuberculosis, 1958, Procee
dings of the XIV Tuberculosis and Chest Diseases Wor
kers’ Conference, Madras.
Idem—Symposium on Changing Trends in Tuberculosis, 1968,
Proceedings of the 23rd National Conference on TB and
Chest Diseases, Bombay.
V Asian and Australasian Congress of Anaesthesiology
Under the auspices of the Indian Society of Anaesthesiology
the 5th Asian and Australasian Congress of Anaesthesiology
will be held at New Delhi on September 23—27, 1978. Over
2933 delegates from different countries are expected to join this
first joint Congress to be held in India for the first time. Further
details may be had from Dr. G. R. Gode, Department of
Anaesthesiology, A.I.I.M.S., Ansari Nagar, New Delhi-110 016-
Stress on Rural Health in the Sixth Plan
b
The Planning Commission has recommended an outlay of
Rs. 1,319 crores for health and Rs. 765 crores for Family WeL
fare Programmes during the Sixth Plan period. For the year
1978-79 alone out of Rs. 146.48 crores agreed to by the Plann
ing Commission for centrally sponsored and central scheme in
the health sector, a major portion of Rs. 115.90 crores would
be spent in rural areas. This information was given by the
Union Minister of State for Health and Family Welfare, Mr
Jagdambi Prasad Yadav to the Consultative Committee of
Parliament attached to the Health Ministry which met recently
at New Delhi.
Members noted that the proposed allocation for the Sixth
Plan was more than double the Fifth Plan provision. However,
there was a strong feeling that even the new outlays, which
amount to hardly 3 per cent of the total plan provision, were
far below the requirements for effectively meeting the health
needs of the country’.
International Congress on Prevention of Heart Diseases and
Cardiac Rehabilitation
The above Congress will be held on September 11—12,
1978 at Bombay. Details may be had from Dr. C. V. Shah,
India House, No. 2, Kemp’s Corner, Bombay-400 036.
International Congress of Hormonal Steroids
The above Congress will be held at New Delhi on October
29—Novermber 4, 1978. Detailed information may be had
from Prof. K. R. Laumas, Chairman and Coordinator, Depart
ment of Reproductive Biology, A.I.I.M.S., Post Box No.
4503, New Delhi-110 016.
Indian Association of Sports Medicine
The Sth Annual Conference of the Association will be held
on November 4-5,1978 at Ludhiana. Detailed information may
be had from Dr. S. Mukherjee, Department of Physiology,
Christian Medical College, Ludhiana-141 008.
II International Migraine Symposium
The 2nd International Migraine Symposium will be hd<
London on September 28—29, 1978. Detailed inform?.'
may be had from the Director, The Migraine Trust, 45 G
Osmond Street, London WC1N 3 HD.
XI International Congress of Leprosy
The 11th International Congress of Leprosy will b.- 1
on November 11—18, 1978 at Mexico City, Mexico. Dcia
information about scientific programme may be had f:
Dr. Stanley G. Browne, Secretary General, Internal i<
Leprosy Asso ci at ion, 57A Wimpolc Street, London WIM, 7j
England and that about registration, hotel reservation. <
from Prof- Fernando Latapi, XI International Congress
Leprosy, Association Mcxicana de Accion Contra la Lc
A. C. or Vertiz 464, Mexico 7, D. F. Mexico.
XIH Session of General Assembly of Confederation of Med'
dissociations in Asia and Oceania
The 13th (mid-term) Council Meeting and Special Meet?
of the General Assembly of Confederation of Medical A:
ciations in Asia and Oceania (CMAAO) will be held on Nov«t
ber 21—22, 1978 in Bali, Indonesia. Further details may
had from the Hony. General Secretary, IMA. IMA Hei
quarters, Indraprastha Marg, New Delhi-110 002.
The Editor is not responsible for the views
expressed by correspondents
Hospital Infections and Human Hair
Sir,—The role of human hair in the causation g! staph;
coccal hospital infection has been underestimated—particul;
so with the advent of the tonsorial fashions—the hirsute c
Stress has always been on nasal and skin carriers and fom
etc., references to the human hair being only a few (Sumn
er a/., 1965; Noble, 1966)
The hospital staff were investigated as a possible source
dissemination of staphylococci during a recent outbreak
staphylococcal infection in a hospital located in a trop
coastal town. From the properly “attired” operation the;
staff, surgeons and attendants, staff from intensive thcr
wards and postoperative wards, hairs that protruded out of
hood and mask were plucked with sterile forceps and drop
directly into glucose broth Nasal swabs were also collet
on serum coated swabs from the same individuals. Fifiy-tlper cent of hairs and only 32 per cent of nasal swabs v
positive for staphylococci, 15 per cent being sterile.
Isolations from longer hairs (more than 10 cm.) were dou
that from shorter hairs .
These isolates were phage typed at the ICMR Staphyloc<
Phage Typing Centre, Delhi; only 22.9 per cent belonged
phage type I, II and III and remaining 77.1 per cent were
typable. The latter, as compared to 30 per cent of untypa
isolates of Summers et al. (loc. cit.') from human pathologi-
Not viewed