A Comparative Study of the Anthropometric Measurements of Positive and Negative Tuberculin Reactors

Citation preview

a

o w & e & o t e s m m d?

MSlSUBfflES OF POSITIVE M B

:: ; KEACTGK3

by pat trie Kuth o* Keefe

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of philosophy* in the Department of Physical Education, in the Graduate College of the State University of Iowa December, 1948

ProQ uest N u m b e r: 10831777

All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is d e p e n d e n t upon the quality of the copy subm itted. In the unlikely e v e n t that the a u thor did not send a c o m p le te m anuscript and there are missing pages, these will be noted. Also, if m aterial had to be rem oved, a n o te will ind ica te the deletion.

uest ProQuest 10831777 Published by ProQuest LLC(2018). C opyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C o d e M icroform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 4 8 1 0 6 - 1346

Dedication

This study Is dedicated to my mother, Mrs. Olive 0* Keefe Roberts

3

AGmmjBMmsm The writer wishes to express her appreciation to all those who helped to make this study possible*

Sincere

thanks are given to the hlgh-sehool girl® who so will~ ingly participated la the testing program, to the nurses, physical education Instructors and administrators of each school in which the measurement® were taken* Special thanks are extended to Br* G. B# MeGloy for his valuable assistance In directing the investigation*

4

Page Introduction*

......

5

His tory of tuberculosis Oost of tuberculosis

Problem*

........

5

.....

6

Humanitarian* .... ...*.*....... Monetary, ........I..**..*,,**.**.*....**..****,*#

6 6

....... ............. . m o * ..........*........

8

Statement of Problem#

.......

literature*

8

.... .***4 4 #**.*#******#

Anthropometric Measurements Body B

u

i

........... l

d

& 8

.

9

Constitution.......................... 10 C

h

e

s

t

*

12

Subcostal Angle*...................... Indices ..................... Vital Capacity*....................... Chest Circumferences* ...... •

16 17 20 23

Weight..................................... 23 Height* ............... 25 Face and Head* ...... 26 ** 26

Exercise. *.*..*.................. Explanation of Major premise. Subjects in Study**.

....... .... .................

28 29

Establishment of Validity of Tuberculin Tests #*...•*• 32 Procedures*...................................

34

34 Experimental#................................. Statistical* .......... .............. .....* 38 Findings*

.........

Summary* Bibliography*

«.......

*................ 46

.... ...... ..........................

52 56

A COMPARATIVE STUDY OF THE ANTHROPOMETRIC MEASUREDEHT3 OF POSITIVE AND NEGATIVE TUBERCULIN REACTORS

IHTRODUCTXOI The eost of tuberculosis In lives, man power and, money la tremendous#

Even a cursory study of the history of this

disease shows how early the attention of mankind was di­ rected to its symptoms and devastating results* History of Tuberculosis Eahumed skeletons of prehistoric periods are said to hear the marks of tuberculosis *35'

9

in Deuteronomy

(seventh century B*C») the following curse is uttered*

"The

Lord will smite thee with a consumption, and with a fever and with an inflammation.w5* Dhap* 28, Vs# 22

consumption

is a term which has been widely used interchangeably with that of tuberculosis*

Consumption, when used as a medical

term, usually means a progressive wasting away of the body, ©specially from pulmonary phthisis *

In the fifth century

B. G., Hippocrates and other Greek writers recognized and described the essential features of this disease*

Aretaeus

in the second century iUD. is said to have given accurate clinical descriptions of tuberculosis*

It Is stated that

the treatment suggested was similar to that which is used today#®5* F* ^

5

6

Cost of Tuberculosis Hmrmni tarlan Although tuberculosis as a disease, and the symptoms of this disease have been recognized for many centuries, in 1940 the death rate was forty-six persons per on© hundred thousand population*3*’

3,46

Tuberculosis is the most common single cause of death be­ tween the ages of fifteen and thirty years*®0 ’

84

From the

standpoint of production and reproduction this is the most valuable period of life* readily be seen*

That this problem is serious can

From fifteen to nineteen years of age, girls

are 5"? per cent more auseeptibl© than boys to tubercle bacil­ li*20’

Most of the scientific information necessary

to eradicate tuberculosis is available*

According to Diehl

all that is needed is the application of this knowledge**14’ P*

42

Monetary The prevention of tuberculosis and the reduction of ill­ ness have a great appeal, principally for humanitarian reasons* In addition, the preservation of manpower is involved, which fact may be interpreted in dollars and cents * "St was ascertained that in a family having an average income of $2590, it costs about #¥500 to bring up a child to the age of eighteen, when the child is said to be self support­ ing*

Up to this age all living costs represent an Investment

7

which has yet to return dividends in earnings*

Death# or

disabling illness, during these eighteen years thus repre­ sents a direct loss# for taking into account the expectation of life at the age of eighteen# the net worth of a person of the #2500 income class# after subtracting the probable future cost of upkeep# is judged to be about $89,000,

When people

die prematurely, the country loses not only the expense of rearing but also the potential net future earnings of that individual*

When expressed in these terms we can begin to

appreciate more vividly than otherwise the money cost of pre­ mature death and disabling Illness.”

This monetary cost was

determined by a Joint committee on Health problems#80* P*

23

the loss of such an Investment is# without doubt# secondary to the humanitarian side; but prevention of such losses is worthy of our greatest efforts.

It la recognised# however#

that the principal coat of the loss of an adolescent Is com­ paratively insignificant when weighed with the loss of a parent on whom there are dependents.

momm Statement of problem Whether differences and similarities exist In body structure, vital capacity and grips between groups that react positively to the tuberculin test and those that react negatively was a problem of special interest to the author of this study*

To determine whether differences and

similarities do exist between these groups, a comparative study of the anthropometric measurements of one hundred positive tuberculin reactors and one hundred negative tuber­ culin reactors was made* A considerable amount of literature indicates that there are differences in the proportions of body structures and in functions In those who have contracted tuberculosis and in those who have not contracted it*

although limited

research in the field of anthropometry has been done with tuberculin reactors, it seemed worth while to study persons who Indicated that they had been Infected with tubercle bacilli and those who did not manifest this Indication* This indication of infection was based on the Mantoux test and in many cases upon X-ray plates. Literature .Anthropometric Measurements Anthropometric measurement for the appraisement of physical condition is not new, but it is not being used by

8

a majority of our medical men*

In discussions with physi­

cians ranking high in the medical profess leas, a sympathetic hearing is given to the subject of anthropometric measure­ ments and to their relationship to diseases or to the ineipiency of diseases, hut the application of such findings receives a theoretical approval and little practical appli­ cation* $hen the practicability of anthropometric measurements in the field of health is discussed with many pedagogical leaders, the impression is received that there is a real need for a simplification of terms and for many more data to help remove measurements from the isolated field of an­ thropometry and to make cooperative progress in a field of mutual interest*

School administrators have been most sym­

pathetic and have Indicated their willingness to cooperate in various types of research as soon as such research is put on a practical basis and In understandable terms for non specialised members in the field of education* Body Build On the issue of the type of body build which has been most susceptible to tubercle bacilli there is evidenced agreement*

The slender type is conceded to have succumbed

more often to tubercle bacilli than the stocky type*

Bryant

terms the slender type as c a r n i v o r o u s P P * 321-326

Bayer

10

as hypofeminine;^> P* Stockard as linear

Bean as hyperon tomorph;49 PP* P*

359

*

Freeman as asthenic,3*8 * P*

and many other designations have Been made*

A majority of

authorities believed that there were sufficient data to sub­ stantiate their findings concerning body build and the lack of resistance to tubercle bacilli*

For future reference in

this study the person of slender proportions will b© termed linear* and the stockier built persons will be termed lateral.

Xn discussions of body build* the term * constitution® according to Draper* Petersen and others has many meanings* By some authorities it is used to refer to inherited factors (genotypic)* while by others to environmental factors (paratyplc) * and by still others to the factors influencing the i whole body as phenotypic. According to Barker* phenotypic is both genotypic and paratypic*2* P* According to Brown there is a relationship between con­ stitution and susceptibility.

He further stated that n there

is an important relationship between weight and sis© of or­ gans to sis© of the individual* have large organs*

The small* wiry person may

The fact is that the mass of organs in

proportion to the weight of the body served is distinctly greater for small than for large persons.

Despite the fact

that the actual weight of organs increases with the weight of the body* the weight per unit of body weight actually dimin-

11

laked*"7 * P*

630

”$bile at present knowledge is limited to

conditions which affect susceptibility as a general proposi­ tion or susceptibility to certain experimental disease# there are definite indications of the manner in which specific sus­ ceptibility is affected*

fher© are two phases of organic

constitution to consider# namely# the organ-bo&y-weight re­ lation or organ balance and the organ equilibrium or inter­ relation of o r g a n s P *

359

fills field of organ-body-

weight relationship is too complicated for the average student# with limited knowledge and facilities# to pursue t© any great extent* Pond©*s conception of constitution corresponds to the etymological meaning of the word (cum and statuer©)*

"It is

governed by what we may tarm a correlation principle# accord­ ing to which the various combinations of organs and organic fluid© and the special relationships or anatomical and func­ tional correlations between the parts of the body which de­ termine the different physical and mental constitutions vary according to the characteristics that are dominant in the Interorg&nic equilibrium**138* P* 18 Petersen believed that

11the

pathology of the ancients

was a constitution pathologyj the body should not be too thin; favorable a square chest with generous growth of hair, the framework well fleshed*

One who possesses such character-

12

is ties has the greatest chance of recovery*

On the other hand,

he who possesses none of these characteristics will die the sooner*

Draper sought to ®link up the machinery

283

of growth, the machinery which gives the human body its shape, texture and constitution with its liability to disorder - to disease***

Intro*

From many authorities it would seem that the tern *con­ stitution® implies the general make-up of the entire body which Includes function and structure*

Although there are

evidences of a return to the constitution of the body and to its relationship to health, there is much unexplored terri­ tory in the aggregate of the physician and in the vital powers of all individuals* Cheat The chest has been the object of more anthropometric study by clinicians than any other part of the body#

11This

interest,® according to Draper, *haa been aroused primarily because the shape and motions of the chest will frequently reflect pathologic conditions of the heart and lungs#

An­

thropologists, too, tend to explain chest differences on a disease basis rather than as expressing individual or racial constltutional factors#*^8 * P* Many explanations have been given to the shaping of the thoracic cavity*

Hutchinson said, 91n the quadruped, on

account of the position and necessity for parallel movement

13

of the anterior limbs, must be turned, so to speak on Its side, and the largest part of the respiratory movement must take place behind the shoulder girdle of which the heaving flanks of the greyhound, or the rapidly galloping horse are striking examples*

In the human, on the contrary, after the

erect position has been assumed and the shoulder masses have rotated outward and backward, in order to give freer play to the tool and weapon, the scapulae come to lie at first on the outer and finally on the posterior or dorsal aspects of the cheat#1*^*

3d*9®

Several studies concerning the shape of cheats during the prenatal period, infancy, and early childhood have been made*

wThe form of the chest,* according to Meredith, achanges

considerably with advancing age*

At birth the child*a cheat

usually measures about the same from front to back as from side to aide*

By three to four years of age the typical

child has chest width equal to one and one-third times the depth of his chest*

Fully half of this relative broadening

and flattening of the chest takes place during the first y e a r # * H u t c h i n s o n stated that uat birth the width and depth diameters of the chest are nearly equal*,f23* p*1197 Welsman noted that "by the time the Infant arrives at the second week of life in the outside world, the infant*s chest Is almost perfectly round, this thoracic index being approxi-

14

mately 100*5*

fills la as near to roundness as the chest will

ever he if it develops n o r m a l l y * H e

further stated

In regard to the childhood index, tffhe flattening process ©onti mes at a fairly rapid rat© until the age of five years, when the thoracic index is about seventy two*

After five

years of age the chest enters a period of much more gradual flattening which continues until adolescence*”^ * ^ * *

^

"The average index for the fifteen to seventeen-year-old girl was sixty-eight and four tenths *

P* ®1

"if we express

the difference between the chest measurements of the newborn Infant after its first inspiration and that of a full grown adult by one hundred per cent, we may say that the chest flattens about sixty-seven per cent during the first year, and that by the fifth year it has attained about eighty-seven per cent of its total flattening, leaving only about fifteen per cent to be attained between five years of age and mafcuri^^«ibi&*, p* S3

belly and deep chest go together*

dernourished children are often victims of rickets*

Un­

Bones

are softer and offer developing muscles little resistance* This helps to explain why the rachitic chest does not develop like the normal chest, but has a tendency to remain round and deep*"3*kld*,pp* 26,27 hiteratur© concerning the "flat-chested consumptive" has changed.

Hutchinson found that the ’"tuberculous chest in­

stead of being flat is relatively round; the anterior posterior (sagittal) diameter Instead of being diminished relatively to

15

the transverse is, on the contrary, increased so that the term, flat chest, as applied to consumptive® is really a misnomer .*1 It appears that for many years, manual after manual in parrot­ like fashion stated that a consumptive Is flat chested* Hutchinson further observed that, from his studies, he believed the conclusion was obvious that th© |{typ© of chest most common in tuberculosis was a persistent immature chest* chest is merely an optical illusion* of the position of the shoulders*

fatness of

It is merely an index

fhe chest with th© long

ant©ro-posterior diameter, being the type of vigor, is just th© reverse and the healthy vigorous human chest is broad, flat, well expanded, and low Indexed type.tt2 S»P£*

1197

Draper found the thorax of tuberculous people to be flat and narrow, and longer than wide, but there was little dif­ ference in the width of the thorax in tuberculous and nontuberculous individuals*^> P* Pryor said that pre-adolescent tuberculous children tended to have barrel-shaped chests when compared with normal children*

the normal chest of th© adult is flat, not round*

4s an individual approaches maturity, the chest Is expected to lose Its infantile shape*^-*

356

In explaining the meaning of flatness, weisman noted that the chest measures about one-third leas from front to back than from side to side or conversely th© depth of the cheat measures about two-thirds of its width#

P*

Davenport also pointed out that *the chest depth grows so much more closely with trunk growth than chest growth*

As

16

growth of the parts of th® body slacks up, the breadth contin­ ues to increase and th© adult proportions of chest breadth are achieved.5*3,3'* PP* 3*4, 2 1 leisjaan explained the flattening of the chest by gravity, by an abnormal shortening of the first rib, by a lack of uni­ formity of all parts of the lungs to Inflate and by th© de­ scent of th© diaphragm*

H© expl&ind th© lack of flatness by

infections of upper respiratory organa and abnormal disorders. He blamed deep cheste&ness partially on faulty diaphragm ac­ tion*

"When Its action is interfered with, it uses its own

center as a fixed point*®4'®# P» 24

Subcostal Angle r fhe subcostal angle of th© chest has received attention from some research students and is indicated by them to be a factor worthy of considerably more study in constitutional resistance to disease#

According to Draper* s findings th©

subcostal angle of the ulcerous and tuberculous individuals is the smallest of that of all groups*

"fhey have a small

subcostal angle, small enslform and chest circumference.

In­

dividuals with narrow chest angles also have short anterior posterior chest diameters*®3'®# P* Fryer agrees with Draper in that an "individual having a subcostal angle between twenty-four and fifty-five degrees had an eighty per cent chance ©f being a member of either the tuberculous or ulcerous groups*

i'he small subcostal angle is

characteristic of the linear type*®41# P*

18

17

Weisman found that th© subcostal angle for normal girls was 75*9 degrees; for th© tuberculous group of similar age, 6Q*7 degrees*

Thus, in the tuberculous chest the subcostal

angle was found to be narrower than in the normal chest*

In

the linear type of body build, according to seme authorities, the subcostal angle was found to be smaller than in the lat­ eral type of body build*

It may possibly be inferred that

the small subcostal angle in the tuberculous chest is merely a concomitant of the linear type of body build*

Ho evidence

on this point is at hand* Indices Davenport used th© thoracic index as the breadth of the chest divided by the anterior-posterior diameter*

In most

recent studies of indices the reverse method has been used* In this study the anterior-posterior diameter is divided by the breadth of the chest*

Changes in the thoracic index de­

pend upon the changes in chest width and chest breadth, and in their relation to each other*

Davenport’s method of de­

termining the Indices resulted in higher indices than those obtained by methods used in later studies*

The Davenport

index could be converted to the one most commonly used by simply taking its reciprocal*

The percentage ratio of the

depth of the chest to its width is the thoracic index to which reference will be mad® later In this study. Hoimal girls from seven to fifteen years of age accord­ ing to the findings of weisman, have an average thoracic index

18

of 70*8 wlilie the tuberculous girls have an average index of 74.8 8 .4 6 > P* When th© depth of the chest is divided by the width, a fraction is given, hut for convenience the result is usually expressed in per cent*

in th© summary of th© thoracic in­

dices of 18,857 Minneapolis school children the average in­ dices of the fifteen, sixteen and seventeen-year-old girls were 68*4*

According to th© survey of Minneapolis school

children, th© thoracic index decreases as age increases up to th© time when maturity is reache&.4b:S,