Bacteriologic Diagnosis of Tuberculosis in Mentally Ill Patients

The causes for the high incidence of tuberculosis in mentally ill patients were indicated. The absence of sputum and the difficulty of obtaining gastric specimens from such patients makes the diagnosis of tuberculosis difficult. The efficiency of the concentrated laryngeal swab technique for cultivation of a small number of tubercle bacilli was compared with the efficiency of gastric lavage in 200 mentally ill tuberculous patients. Solid and liquid media were used for the cultivation of laryngeal swab material. One gastric lavage produced 30.5 per cent, one laryngeal swab gave 24.5 per cent positive cultures of tubercle bacilli. One laryngeal swab added 7.5 per cent positive cases to those detected by gastric lavage. The liquid medium produced 16.5 per cent early cultures and revealed the pathogenicity factor, the cord formation, of the bacilli. The "esthetic factor" greater swallowing of sputum in females than in males, is lost in mentally ill patients.