百日咳ニ關スル統計的研究

概要

論文の詳細を見る
From the statistical observation of 1794 Gases of whooping cough Which were treated in our clinic during 10 years (1925-1934) the following conclusions were deduced. 1) Sex Incidence: In the total number of patients there was a slightly larger number of males than females: 911 males to 883 females. The mortality is greater among males than among females (4.6% to 3.8%), but among children under one year of age the contrary is true (9.3% to 11.5%). 2) Age Incidence: The largest number of Gases occur in children under one year (22.1%), then it decreases by degrees with the advance in age. The mortality is almost proportionate to age incidence. 3) Seasonal Incidence: It prevails in the following order: most in June, then July, and May; and least in December, then November. Mortality is highest in March, then Oetober; that is, in the seasons of transition. 4) Nursing Method: Normal prevention against pertussis-bacillus is not transferred through mother's milk, therefore a larger number of suckling babies than bottle-babies is affected in consequence of many chances of infeetion with mothers' pertussis in suckling. The outbreak of complications, especially of pneumonia, has relation to the nursing method: that is, it occurs frequently in bottle-babies. The mortality of babies suckled over three months is far lower than that of bottle-babies because of better nutrition, and on the whole the mortality of those babies which have been suckled or fed mixed nourishment is lower than that of bottle-babies (4.5% to 8.5%). 5) Environment: The facts that there are no deaths in doctors' families and that the lowest mortality is among the educated ciasses prove that early discovery and therapy against pertussis exert great influence upon its prognosis. 6) Symptoms and Chief Complaints: Coughing particularly at night (36.0%), swollen eyelid (29.2%), vomiting (24.4%), whooping (23.9%), ulceration of the fraenum linguae (14.9%), fever (20.7%), want of appetite (14.2%), sleeplessness (12.5%) etc. 7) Chief Symptoms and Age: Whooping is found mostly between 1 and 2 years, ulceration of fraenum linguae between 4 and 5 years, vomiting and diarrhoea under 1 year, swollen eyelid under 5 rears, coughing at night least in the suckling period, bat more as age advances. 8) Fever: Absence of fever is most frequent (53.1%), 37.0℃-37.5℃ temperature is common in 32.8% of the Gases. As a rule it is relatively high under 2 years. If complication be absent, there is no fever in 60.4% of the cases, if present, it occurs in 47.5% of the cases. The absence of fever in many cases is peculiar to pertussis. 9) Complications: Bronchitis (50.0%), angina (14.9%), pneumonia (6.8%) are the most outstanding; adenitis cerv. (5.7%) et submax. (0.6%), enlarged tonsils (1.9%), encephalitis (0.8%), meningitis (0.7%), enteritis (1.6%), measles (1.6%), chicken-pox (1.5%), diphtheria (0.8%) also occur. 10) Mortality: Of the total number of patients, 53.3 percent of the deaths were due to a broncho-pneumonia, then meningitis (12.0%), encephalitis (10.7%), enteritis (9.3%), empyema thoracis (6.7%). Deaths due to pneumonia occur mostly among those under 1 year of age (67.5%), enteritis in the period of ablactation (57.1%), encephalitis between 1-2 years. 11) Respiratory Complications: Especially bronchitis occurs in the following order: most in January, then September, February, October, March. Pneumonia occurs most frequently in March, then Ostober; and its prognosis is bad in August, July and October. Complicating bronchitis and pneumonia occur usually after one month has elapsed since the beginning of pertussis (31-40), namely in the last part of the paroxysmal wage. The complication of pneumonia is found most frequently in the paroxysmal stage and adds greatly to the danger. 12) Charge in the lungs: In many cases of bronchitis dry rhonchus is heard in right side, espeeially in the right lower lobe, moist rale is heard in most cases in the left lower lobe, then in the right lower lobe in slightly fewer cases. The focus of pneumonia is more likely to be in the left side, than in the right side, especially in the left lower lobe. 6.5 percent of all pneumonia is lobar pneumonia, which localizes largely in the right upper lobe and Shows good prognosis. 13) Fever-curve of Pertussis-pneumonia: It appears slightly more frequently in intermitting form, than in continuous form. The Former is more usual in severe suckling-pneumonia, the latter in patients between two and three years. The younger the child, the shorter is the lapse from the beginning of pneumonia to death. 14) Subsequent Diseases after Pneumonia: It appears in most cases as encephalitis (32%) and in fewer cases as enteritis etc. Prognoses in enteritis, empyema and meningitis are all unfavorable. 15) Roentgenologic Examination of the Pertussis-lung: It shows enlarged hilar hilar infiltration and lymphoids; it also shows peribronchial Infiltration in spite of the fact that there is no respiratory complication. If bronchitis be present, the above-mentioned images become very evident, also pleuritis diaphragmaticum is often Seen. If pneumonia be present an increase in dense lobar shadows or hilar localized areas of infiltration become evident. 16) Complications in the Nervous System: They are often seen (1.4%) as meningitis (tuberculous, serous and pneumococcal), encephalitis, acute poliomyelitis (the cerebral type). Serous meningitis is seen particularly in children under 1 year; tuberculous meningitis and encephalitis after ablactation in those under 2 years. Serous meningitis prefers to attack males, and tuberculous meningitis, females. Complications of the nervous system usually occur in the paroxysmal stage (77.8%), then in the decremental stage (14.8%), rarely in the catarrhal stage (3.7%) and have no relation with the season. 17) Disposition: So far as dispositions are concerned exsudativ diathesis gives as a rule good prognosis; an the contrary, 12.0% of the children with rickets constitution die by pertussis and often there are complications of pneumonia in such cases. 18) Vaccination: The mortality of pertussis among infants which have not been vaecinated is higher than among vaccinated ones; also infection of pertussis directly after vaccination passes without complication. Measles: The mortality of pertussis among infants which have had measles is higher than among those which have not had it, but proximity of infection of both measles and pertussis give rise to unfortunate consequences (namely complicating of pneumonia in 11.7 of the cases, mortality in 9.8%). The infection of measles shows relatively good prognosis. Chicken-pox, scarlet fever, diphtheria and german measles often become complicated with pertussis, but do not unfavorably affect the normal course of the pertussis. Tuberculosis: The Pirquet test in suspicious cases of tuberculosis showed positively 34.1%, negatively 65.9%, in 70.0 percent of the deaths negatively. 19) Relapse: 1.0% of the total number of patients showed relapse of pertussis. The interval between the two attacks is at the longest 4 years, at the shortest, 1 month. Subsequent outbreaks occur frequently, caused by influenza, parotitis, etc.
京都府立医科大学の論文

著者

三宅廉
京都府立醫科大學小兒科教室

百日咳ニ關スル統計的研究

スポンサーリンク

概要

著者

関連論文

スポンサーリンク