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

November, 1951 The Health Bulletin 11early investigation of suspicious symptoms;but its statistical effect in reducingthe death rate cannot be calculated.There is no doubt that the programof control stimulated by the foundersof the National Tuberculosis Associationhas played a very large part inaccelerating the decline in the deathrate which had already been initiatedby the genetic factor and reinforced byimprovement in economic conditions.However, we cannot assign a numericalor percentage value to this program. Inonly a few isolated instances is it possibleto study population groups wherethe genetic, racial and economic factorsare really comparable. In such a situationhere in North Carolina there wasa lower death rate and a progressivedecline in counties where all cases couldbe treated adequately.Tuberculosis TodayPAfter congratulating ourselves andadvertising to the public our phenomenalsuccess in lowering the deathrate of tuberculosis from 200 per 100,000to 22.2 per 100,000, we must admit thatF the death rate is not and never was anf accurate measure of the importance ofthe tuberculosis problem. This statementis true even though tuberculosis remainsthe chief cause of death from disease inindividuals between the ages of 15 and34 and kills more people than all theother infectious and parasitic diseasescombined. The deaths in 1950 of 33,557individuals from a disease which Isknown to be preventable is indeed anappalling loss of himian resources.Our chief problem today is the living,not the dead. It is the living victims oftuberculosis who suffer physical painand mental anguish, whose homes arebroken, whose families are impoverished,and finally it is the living who spreadthe disease to healthy individuals. Wedo not know the actual number of casesof tuberculosis among the citizens of theUnited States. The studies by Edwardsand Drolet in 1950 and the data compiledby Dempsey, indicate that themorbidity rate does not parellel that ofthe death rate.The value of mass radiographic surveyshas been questioned on the groundsthat the cost is excessive when dividedby the number of active cases of tuberculosisdiscovered by this method. If weare thinking only of the individual patient,the cost might be considered excessive,but the primary object of thetuberculosis control program is the detectionand isolation of the spreaders ofthe disease. One such apparently healthyspreader may easHy infect a sufficientnumber of healthy individuals to costthe public eventually himdreds of thousandsof dollars. There is also the educationalvalue of a mass survey to beconsidered. Another defect pointed outis the possibility suggested by Dr. J.Arthur Myers and supported by Dr.Robert F. Young that those who respondto an invitation to have freeX-rays are not truly representativesamples and suggests that there mightbe even more tuberculosis of a moredangerous type in those who were notreached as in those who were studied.The routine X-raying of all admissionsto hospitals and clinics is giving arate of 10-18 per 1,000 and shows manymore moderately advanced and far advancedcases than does mass surveys ofapparently healthy individuals. Calculationsbased on the most conservativefigure of 0.6 per cent indicate that morethan 40,000 unrecognized cases of tuberculosisare admitted to the generalhospitals of the United States each year.As of today, not one state or one countyin the United States has an entirelyadequate case-finding program and thisstatement includes those states andcounties where the death rate is below20 or below 10 per 100,000 as well asthose with higher rates. In all of theseareas there are unknown, imdetected,open cases which are spreading the infection.It is axiomatic that a case-findingprogram cannot fimction eflScientlywithout an adequate number of sanatoriimibeds for the hospitalization ofthe active cases discovered by the survey.One survey published in 1950 showsthat only six states had 2.5 beds perdeath and seven had less than 1. Presentcalculations indicate that the ratio