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

10 The Health Bulletin November, 1951education is the foundation upon whichthe program rests.The 1950 Seal Sale in North Carolinawas $422,204.46. Six per cent of thisamount was sent to the National Association.The other 94 per cent was keptfor work in North Carolina. Sixty-fivethousand, three hundred fifty dollarsand eighty one cents was budgeted tothe North Carolina Tuberculosis Associationfor its program and the largerportion or $331,522.17 is being spent onlocal programs in the counties where themoney was raised. Listed below are theexpenditures of the NCTA for the lastfiscal year:Health Education andInformation $30,925Rehabilitation 2,392Administration 8,296Seal Sale 8,036Research 4,222Field and Organization 16,126TUBERCULOSIS IN THE UNITED STATESYESTERDAY—TODAY—AND TOMORROWBy David T. SmithProfessor of Bacteriology, Duke Medical SchoolPast President of the National Tuberculosis AssociationDurham, N. C.(Condensed from a tallc given at the Annual Meeting of NTA,Cincinnati, Ohio, May, 1951)It is appropriate at the mid-centuryto look back at the accomplishments ofthe past 50 years, to evaluate the problemsof today and to make plans for thenext 50 years.Progress made in the control of tuberculosisis truly phenomenal whenmeasured by the decrease in the deathrate. The rate has fallen from approximately200 per 100,000 in 1900 to a provisional22.2 in 1950. At least four majorfactors have contributed to this decline:(1) constitutional resistance with geneticselection and propagation of the moreresistant individuals (2) a marked improvementin the general economiclevel of the population, (3) education ofthe public about the importance of anearly diagnosis, and (4) the detection,isolation and treatment of the opepcarriers of tubercle bacilli. It is difficult,if not impossible, to evaluate therelative importance of these four factors.Although the genetic factor is beyondour control there is evidence that it hasbeen in operation a long time in WestemEurope. The decline in death ratefrom tuberculosis as revealed by Englishstatistics began many years before Kochdiscovered the tubercle bacillus and beforemodern methods of isolation andtreatment were introduced.The importance of the economic factorcan hardly be over-emphasized and yetwe must confess our ignorance of therelative significance of environmentalsituations such as excessive labor, restrictedrecreation, inadequate housingand a poorly balanced diet. Some observationsby Robinson during World WarI and World War II suggest that a properlybalanced diet is the most importantsingle factor in increasing the resistanceto tuberculosis. A study of occupationalmortahty groups by Whitneyshowed that the tuberculosis death ratein the poorest paid day laborers wasseven times as high as among the professionalgroups. The minimal deathrate from tuberculosis was not amongphysicians, as might have been expected,but among bankers, brokers andmoney lenders.The educational campaign carried onby the National Tuberculosis Associationand its affiliates has been very effectivein removing the stigma from the diagnosisof tuberculosis and stimulating an