Bacteriologic diagnosis of tuberculosis in mentally ill patients.

It is hard to handle and to treat a mentally ill tuberculosis patient. His tuberculosis governs the field of treatment often to the detriment of his mental condition. The impossibility to impose the rules of elementary hygiene on the mentally ill is chiefly responsible for the high incidence of tuberculosis among the patients of mental institutions. In 1950, the 231 institutions for mentally ill in the United States, with the total population of 511,064, reported 13,911 cases of active tuberculosis, that is 2700 per 100,000 inmates, compared with the 80 cases in the general population of this country. (Bettag, 1952.) To prevent the spread of this disease, the early diagnosis of open tuberculosis is of utmost importance in mental institutions. Obtaining the necessary material for the diagnosis from a mentally ill patient is connected with great difficulties. Due to their aggressive behavior there are patients at Anoka State Hospital from which such material can be obtained only rarely. It is almost impossible to collect the most important material for tuberculosis diagnosis, sputum, from a mentally ill person. According to Burns, 1945, in the institutions for the mentally ill of Minnesota it was extremely difficult to get a specimen of sputum from more than 2 or 3 per cent of the patients. Even though cooperative, the mentally ill patient rarely understands the difference between sputum and saliva. Consequently, the most suitable material available, would be a gastric specimen. Unfortunately, gastric lavage is a long and disagreeable procedure among mentally ill people. This is particularly true if the first lavage is not easily performed. These circumstances motivated our attempts to find an easier way to collect pathologic material for tuberculosis diagnosis. The laryngeal swab for collecting tuberculosis material is recognized as an easier, more rapid and less time consuming procedure for collecting tuberculosis material than gastric lavage. We investigated the usefulness of this method in mentally ill patients.