The tuberculin reaction in patients of the Fiji leprosy Hospital

The patients of the Makogai hospital have been tested with tuberculin on two occasions widely separated in time. Yhis was first done in 1917 by Hall with the von Pirquet test, when he found 65.5 per cent of 121 patients to be positive, that being about the same rate as had been recorded for a normal group in the general population. In the recent tests, made by me in 1947-1948 and 1949-1950, in two series comprising a total of 869 patients, the mantoux method was used with varying dilutions of old tuberculin. The over-all positive rate of the first group of 645 patients was 53.5 per cent, but the maximum dilution used was only 1:1,000 except in 6 cases. In the second group of 224 newly-tested cases the maximum dose was a 1:100 dilution, and the positives were 80.6 per cent. Analysis of the data with regard to type of the disease reveals an apparent tendency for tuberculoid cases to give more positives than lepromatous cases. The difference was 10.3 per cent in the first group tested, 15.5 per cent in the second group, both of these differences were statistically significant. The results in the first group with the first dilution used (1:10,000) are contrary to the idea that with low dosage there may be a greater difference between the two types than with higher dosage. The higher prevalence of tuberculous infection, as represented by sensitivity to tuberculin, among the Fijians than the Indians and even the Gilbert Islanders is indicated by the total figures by racial grouping, but particularly by the results in the second group (95.5 per cent, 68.3 per cent and 86.8 per cent respectively)

A study of leprosy in Fiji

Leprosy has been in existence in Fiji from a very early date. A leprosy station was established by the Government of Fiji on the island of Bega in 1900, and the ´present hospital at Makogai was opened in 1911 to 427 in 1933. Of the 1,365 cases recorded, 54.7 per cent were neural in type and 45.3 per cent were cutaneous. Investigation serves to indicate that there is no such condition as pure cutaneous leprosy without some degree of nerve involvement. The sex ratio of the patients was 3.2:1, with 76 per cent males and 24 per cent females. No evidence appears that sex played any part in determining the type or course of the disease in these patients. There have been 417 deaths in the series, of which about 50 per cent could fairlly be attributed to leprosy. Of the cases dealt with, 24 per cent have been conditionally discharged. There were 33 readmissions, of which 8 have been redischarged to date. The most satisfactory improvement occurred in the earlier nerve cases, and it is found that while all types can be improved the prognosis of cutaneous cases as regards cure is comparatively poor.