Tuberculosis as a Navy Problem

¹ Washington, D. C.

1) The rates for Original Admissions to the sick list for tuberculosis in the U. S. Navy have steadily declined in the past 40 years from a high of 671.83 per 100,000 average strength in 1903 to a low of 53.17 per 100,000 in 1942.

2) The rise in Admission rates and Invalidings from the Service at the beginning of the present war period due to tuberculosis is directly attributable to chronic, pulmonary, arrested tuberculosis. This increase is apparent rather than real, since it represents improved case-finding rather than more tuberculosis, and infection existing prior to entry into the Service rather than that incurred in line of duty.

3) Death rates and noneffective ratios for tuberculosis (all forms) and particularly for tuberculosis, pulmonary, chronic, active, show a downward trend, the rate of decrease being accelerated in 1940. This drop in 1940 simply reflects the increased rate of invaliding men from the Service.

4) The first material advance toward eliminating tuberculosis from admission to the ranks of the U. S. Navy was the inauguration of mass roentgenographic examination at the Norfolk Naval Training Station in January, 1941. The subsequent expansion of this program greatly improved the Navy's case-finding, thus causing Admission rates and Invalidings from the Service to undergo sudden, precipitous increases. At the same time, however, this procedure also eliminated potential sources of tuberculous infection through the policy of separating these foci from the Service rather than retaining them on active duty.

5) The scheme which was placed into operation in February, 1943, in the Selective Service Induction Centers and which makes entrance into the Navy contingent, among other factors, upon a satisfactory photofluorograph of the chest appears to have approached even closer to a solution of the problem of keeping tuberculosis out of the Navy.

6) The Original Admission rates for all occupations in the Navy due to tuberculosis (all forms) have for many years been comparatively low, and, since 1922, have consistently followed a descending trend line. Despite this favorable trend, it is nevertheless true that three occupational groups, i.e., hospital corps, culinary and engine room, have maintained rates almost consistently above the mean rate for all occupations. The need for further study and effort in the solution of this problem is obvious.

7) Roentgenographic chest examination before entry, combined with roentgenographic and clinical studies upon the occurrence of clinical symptoms, will markedly reduce the incidence of tuberculosis in the Navy. That these devices alone, however, will effect the complete eradication of tuberculosis from the Navy is subject to question in the light of the results of a sample survey of the crew of a Navy cruiser. In this study, it will be recalled, 0.42 per cent of the ship's 713 enlisted personnel were found to possess clinical tuberculosis of severity sufficient to cause separation from the Service.