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Title: The incidence of tuberculous infection among the native inhabitants of the Gold Coast and its bearing on the question of immunity
Author: Greer, W. N.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1936
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In the Report of the Principal Registrar of Deaths in the Gold Coast for 1933 it was stated that during the previous three years the proportion of deaths from pulmonary tuberculosis had far exceeded that of all other killing diseases with the single exception of non- tuberculous affections of the respiratory tract. This disease accounted for 9.9 per cent. of the total deaths in 1931, 9.2 per cent. in 1932 and 10.5 per cent. in 1933. Tuberculosis of the respiratory tract and consequently the most infective form of the disease was far more common than any other type. In 1933 deaths from pulmonary tuberculosis numbered 658 as compared with 47 from other forms. In the Report of the Medical Department, Gold Coast, for 1932 -33, the Director of Medical Services wrote that the tuberculosis problem was one of the most important to be faced. He attributed the high incidence of this disease to insanitary housing, overcrowding, a total ignorance of the rudimentary laws of hygiene and lack of immunity. This lack of immunity associated with scanty tuberculisation of the native races is stressed by Young' in discussing the spread of tuberculosis among the African population of Nigeria. As resistance to a disease may be natural or acquired, so lack of it may be due to inherent susceptibility or to absence of opportunity to acquire immunity. According to Opie, there is' no proof that the negro race has any inherent susceptibility to tuberculosis, and in another report, the same author writes: "There is indeed very little convincing evidence for or against the opinion that inherited susceptibility on the one hand, or inherited resistance on the other, modifies the progress of tuberculosis in human beings ". Carter, on the other hand, has tried to show that the black races have less innate resistance than the white. He cites the results of sanitorium treatment to show that tuberculosis undergoes improvement more frequently in white people than in negroes, and he attaches particular significance to the observation that Mulattoes are in this respect intermediate between whites and blacks. He points out that Mulattoes and blacks live under practically identical environmental conditions, and he concludes that the Mulatto is more resistant because the White race has transmitted part of its inherited immunity to him. Carter has not considered the other possibility that the whites have by contact transmitted the disease to the Mulatto, and that by reason of this, acquired resistance may have been established. This possibility cannot be excluded. Fishberg states that tuberculosis is inherently not a racial problem and that one human race or ethnic group, when first encountering the tubercle bacillus, is as vulnerable to infection as another. It is only after they have been exposed to infection for generations that they acquire a certain degree of resistance which causes milder clinical forms of the disease than are found in races which are virgin soil to the bacilli. It would appear, therefore, that any want of immunity on the part of West African natives is due rather to lack of opportunity to develop resistance than to any hereditary or racial predisposition to the disease. This view is supported by Griffith6, who says that races previously free from tuberculosis are much more susceptible to the disease than those who have long been exposed to infection. He attributes the greater resistance of infected communities either to a weeding out of the more susceptible human beings, the resistant individuals surviving, or to an acquired immunity produced by slight infections which have been overcome. As acquired immunity depends on exposure to infection it would seem necessary to know the incidence of tuberculous infection before one can consider the degree of resistance to tuberculosis which a given population may have developed. A comparison of the infection rate with the mortality or morbidity rates would then give a measure of the acquired resistance of the population in question. A high infection rate associated with low mortälity or morbidity rates would suggest a considerable degree of resistance; the reverse condition would point to a low degree. It was because the author was unable to find any record of the incidence of tuberculous infection among the native inhabitants of the Gold Coast that the present investigation was begun.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available