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

July, 1951The Health Bulletinthem, at least, relative to active followupwork.Following the mass survey, a gradualdecline occurred in the death rate fortuberculosis for the total population,and we noticed that for some resison the"culprit" was not as willing, or even asanxious, to risk a fight in the open ashe had been In the early 1940's. Alongwith this decline for the county, as awhole, we noticed a tendency for therenegade to make forays on certainisolated groups in the county. Was thisa retreat "Into The Hills" and a changeto gorilla warfare. In view of these findings,it was decided to "meet fire withfire" by planning an intensive, epidemiologicaltype x-ray survey in this areafor this particular group.A review of the morbidity and mortalityrates for tuberculosis in the varioustownships in the county over athree-year period revealed a significantnumber of cases and deaths occurringin a selected group of the populationin this particular area of the county.As previously reported,(i) "Althoughthis township represented only fifteenper cent of the total population, durihgthe three years preceding the specialx-ray survey (January, 1950), twentyfiveper cent of aU tuberculosis deathsin Halifax Comity occurred there. Whileonly nineteen 'per cent of the negropopulation lived within this township,thirty-four per cent or approximatelyone-third of all negro deaths from tuberculosisin the coimty during the threeyear study period occurred in this area.Moreover, throughout the county as awhole, where the negro population constitutedfifty-eight per cent of the totalpopulation, sixty-six per cent of thetotal deaths from tuberculosis wereamong negroes; whUe in the Enfieldtownship during the same three-yearperiod, eighty-eight per cent of thedeaths from tuberculosis were negroes.During 1947 and 1948, one hundred percent of the deaths from pulmonary tuberculosisin the Enfield township werenegroes."A spot map, pin pointing the casesand deaths from this disease during1947, 1948 and 1949, was used to localizethe principle tuberculosis problem InHalifax County within this township.Prom the spot map study, the tuberculosisproblem localized itself still fiu--ther within the township aroimd seventeendistinct communities."In order to establish a base line todetermine exactly the number of negroesliving in these seventeen commimities,the negro principals and teachers inthis area were called upon to conducta census."During the organizational and educationalphases of this special epidemiologicalsurvey, all efforts were directedtoward the particular group in question,namely, the negroes in a selected area ofthe Enfield township. We had no streetbanners, brass bands, window placards,posters or parades. Rather the individualapproach was followed as strictly aspossible. This type of approach wasmuch more difficult than the mass approach,and I suppose that pioneerworkers in public health would have referredto It as 'shoe leather' epidemiology."A negro principal in the area, itseems to the writer, hit the nail squarelyon the head when he said, 'Doctor, mypeople are Ignorant and superstitious.Many of them are afraid of this type ofthing. Many of them do not receivenewspapers, and, moreover, many ofthem do not even read. A lot of mypeople do not have radios. You will haveto sit down with them in a personal appealin order to persuade them to comein for these x-rays'. Therefore, everyavailable member of the health departmenttogether with lay workers weredispatched to these various seventeencommunities during the x-ray survey inorder to make personal appeals to thesepeople in an effort to get them in forx-ray. Appeals were also made to allland owners In this area for their cooperationin furnishing transportationfor their tenants. Each of the seventeencommunities was given a specific dateon which to report to the x-ray bus."This special survey resulted in thex-raying of 2,790 citizens, of which 2,107were negroes, representing sixty-fourper cent of all the negroes in the study