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

6 The Health Bulletin July, 1951area. Forty-two cases of significant tuberculosis,including five hospital cases,were revealed, giving a discovery rateof 1.8 active cases per 1,000 citizensx-rayed, compared to less than 1 per1,000 for the state as a whole and to.8 per 1,000 as discovered in the conventionalmass x-ray s'orvey conducted inthe county in 1946.Including seven additional hospitalcases diagnosed immediately followingthis survey, and from this same group,a discovery rate of 4.3 hospital casesper 1,000 citizens x-rayed during andimmediately following the study resulted.These seven cases did not report tothe x-ray bus during the scheduled survey,in spite of all the intensive effortsof the workers to get them. These findingspoint up some of the difficulties offighting "In The Hills."The staff had hardly recovered fromthis epidemiological survey when thegood news was received from Dr. WilliamA. Smith, Director of the Sectionof Tuberculosis Control, State Board ofHealth, that five mobile x-ray unitswould be coming our way by the followingJanuary, 1951, for a second massx-ray survey of the total populationin the county. This, then, introduced usto the fourth and most recent phase ofcase finding for tuberculosis in HalifaxCounty.As a result of our studies in the specialsurvey, we decided to apply as many ofthese epidemiological principles to thesecond mass x-ray survey as possible.Under the excellent direction of MissLula Belle Highsmith, Public HealthEducator from the Section of TuberculosisControl, State Board of Health,and with the capable assistance of herassociate, Mrs. Mildred Page and, alsoMrs. Velma Joyner from the NorthCarolina Tuberculosis Association, asplendid organizational and educationalprogram was planned and executed,prior to the actual x-ray schedule. Thefollowing factors were emphasizedthroughout these preliminary stages:(1) All contacts of known tuberculosiscases must be x-rayed regardless of age;(2) Importance of x-raying all negroes,particularly those in the lower economicgroups; (3) Since mass x-ray surveysthroughout the county had revealed thereservoir of active tuberculosis to beamong older people, it was emphasizedthat all citizens forty-five years of ageand older, and particularly those sixtyfiveyears of age and older must bex-rayed; (4) Importance of all ruralagricultural workers being x-rayed, sinceit had been noted that this group inthe previous studies in North Carolinahad shown a high incidence of tuberculosis.In order to highlight the importanceof the individual approach in the secondmass x-ray survey, working committeesfor both white and negro groups wereorganized in each major community inthe county rather than having oneoverall committee or group for the entirecounty. The four special factorsmentioned above were stressed in all ofthe meetings; and, also, it was emphasizedthat the several working committeesshould continue their effortsthroughout the entire x-ray schedule inorder to sustain interest in the project.Needless to say, the entu-e staff ofthe health department, particularly thenurses, were briefed again and again onthe special epidemiological factors whichwe felt were of particular importance atthe time of this survey.Inasmuch as the previous mass x-raystudy in this covmty, as well as the resultsof the x-ray surveys throughoutthe coimty, had been largely non productiveof active reinfection tuberculosisamong school children, no special scheduleswere made for the schools in thecounty; however, school children overfifteen years of age were urged to comein to the buses at the regular locations.Even though we did not include theschools in our x-ray schedule, an intensiveeducational program was conductedthroughout the three school systems inthe county during the entire study.In setting up the x-ray schedule forthe county, not only population densities,transportation and availability ofpower were considered, but the mofbidityand mortality rates for the variouscommunities were also used as importantfactors in determining the exact