The Health bulletin [serial] - University of North Carolina at Chapel Hill

second within five years (the first massre-survey in the state), and from whichthe smoke of battle has hardly cleared.The first phase of case finding activitieswas carried out with the best facilitiesat the disposal of the agency atthe time and when tuberculosis waswide spread both as to population groupsand as to the geography of the county.The five year median tuberculosis deathrate in Halifax County during this firstphase (1941-1945) was 58 per 100,000population compared with a rate of 35for North Carolina as a whole. Duringthe early 1940's, there were many tuberculosisfamilies in the covmty and thedisease seemed to be more devastatingin its attack on the family than at thepresent time. It seemed to be the usualthing then to find secondary cases ofthe disease in families where active casesexisted. Thus, even though the diseasewas attacking on a broad front, out onthe plains, the Official Agency had tobe content with rather limited defensemaneuvers within limited groups of thespopulation.Then came the remarkable developmentof the photoflurographic x-rayunit and with it the mass x-ray surveytechnique. When the four mobile x-raybehemoths, furnished by the StateBoard of Health and the United StatesPublic Health Service, rumbled IntoHalifax County on that bleak day inDecember, 1946, together with the necessaryprofessional, technical and clericalpersonnel, we in the health department,and our loyal cooperating agencies, felta surge of confidence and felt, too, thatthe battle with tuberculosis had changedfrom a defensive to an all out offensivemaneuver—tank warfare on the plains,if you please.The intensive public health educationalphase which preceded the massx-ray survey of 1946 was planned toreach all groups of the population in allsections of the county—school children,industrial employees, agricultural workers—everyonefifteen years of age andolder. Tuberculosis at that time wasthought to be wide spread in most groupsand in most areas in the county and,therefore, this type of educational cam-The Health Bulletin July, 1951paign was geared for the time.Another important factor in connectionwith this first mass x-ray surveywas the setting up of as complete andaccurate a tuberculosis register as possible.The many records and files of thehealth department and in the physiciansoffices were searched dUigently vmtil allknown cases of tuberculosis and theircontacts were tabulated.When this first mass attack on tuberculosishad been completed, our tuberculosisregister groaned under the heavyaddition of two hundred and forty-fournew cases of significant tuberculosis inall stages; moreover, twenty new activecases were added to the county andstate sanatoria, resulting in a discoveryrate of .9 hospital cases per thousandcitizens x-rayed.Also, in connection with and immediatelyfollowing this first mass x-raysurvey, a weekly x-ray and fiuoroscopicclinic was organized and has operatedcontinuously since that time to whichall suspected cases and all contacts oftuberculous families have been referredas indicated.The back breaking work of visitingall of these tuberculous homes has beenfaithfully carried out by our nurses tomake certain that the necessary laboratorywork, tuberculin testing and othercase finding activities were done, inaddition to the x-ray diagnostic work.This first mass survey in HalifaxCounty resulted in the x-raying offifty-eight per cent of the x-ray population,but the question that reared itsugly head immediately and that hashaunted us until the present time hasbeen, "what of the forty-two per centwho did not report for x-ray."It has been our experience that thefollow-up activities of a mass x-raysiu-vey must be relentless, and the questionas to when a suspected case orapparently arrested case of tuberculosiscan be ultimately closed is certainlyone most difficult to answer. We havefollowed many of these suspected casessince the original survey in 1946 onlyto have some of them become active inthe past six months, or at a time whenwe were seriously considering closing