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

12 The Health Bulletin November, 1951should cartainly be at least 3 beds foreach annual death. The number of newbeds needed in the United States calculatedon this ratio is 39,291 or approximatelyone-third more than we have atthe present time. Even this number isa conservative figure and definitelylower than the 58,815 estimated as neededby the U. S. Public Health Servicewhich made its calculations from theaverage number of deaths in the 1940-44period.Tuberculosis TomorrowOur plans for tomorrow must be subdividedinto (1) the near future and(2) the distant futvure.It is imperative that more comprehensivecase-finding programs be formulated,adequate nimibers of sanatoriimibeds be built, and effective follow-upand rehabilitation be provided. Whenthis goal has been reached we can planthen the more distant future in whichthe tubercle bacillus will be eliminated.In the past we have used the deathrate as our guide to progress, althoughit was never an accurate measure ofthe magnitude of the problem. For thepresent we use the case incidence, ormore precisely the case report rate, althoughwe realize that many cases remainundetected and unreported. In thefuture we must focus on the amountof tuberculous infection in the populationin contrast to tuberculous disease.Tuberculous Infection is measured withthe tuberculin test. Healthy individualsharboring virulent tubercle bacilli intheir bodies have no symptoms andusually pass successfully all examinationsincluding X-rays of the chest andyet they may become in a few monthsor years new active cases capable ofspreading the disease to others. Theability to harbor living virulent tuberclebacilli in the body tissues without developingclinical tuberculosis is controlledpartly by the genetic factor andpartly by economic conditions. Of thetwo the latter is definitely more important.This was shown during WorldWar I and World War II in the populationof Western Europe where the geneticfactor has been in operation for severalthousand years and yet during thesewar years, with their accompanyingeconomic disruption, the death ratedoubled and quadrupled. Our own populationis not safe from a similar reversalof the case rate and death rateas long as Uving vinUent tubercle bacilliare being harbored in the tissues of aconsiderable proportion of the population.In 1900 in urban areas nearly 100per cent of individuals over 15 years ofage gave positive tuberculin tests andeven in rural areas 50 to 75 per cent ofadults were positive. Large scale tuberculintesting 25 years ago, as a part ofthe then current case-finding programs,showed a decline to about 75 per centin urban populations and 25 to 50 percent in rural areas. Tuberculin testingas a case-finding method was abandonedin favor of mass radiography and so welack current information regarding thetuberculinization of our people as measviredby the tuberculin test.On the basis of studies made showingtuberculin reactors in the different agegroups, from 4.2 per cent to 20.2 percent, if the extremely conservative figureof 10 per cent tuberculin reactors ismultiplied by the total popvUation of150 millions, we find that at least 15,-000,000 citizens may have virulent tuberclebacilli in their body tissues. Asmall, but unkown, percentage will developclinical symptoms and an evensmaller fraction will become disseminatorsof tubercle bacilli; but these15,000,000 remain a potential danger tothemselves and to their fellow citizens.Hence, our goal for the future must bethe reduction of the tuberculin reactorsfrom 15,000,000 to 0.Universal B. C. G. vaccination is notthe answer to the problem. The degreeof immunity induced by B. C. G. vaccinationis slight and transient. Furthermore,the artificial induction of a positivetuberculin destroys the value oftuberculin testing as a guide to our successin eliminating tuberculous infectionfrom the population. The tuberclebacillus can be completely eliminatedby our standard methods of detection,isolation and treatment provided thesemeasures are applied with sufficient