Health Department Efforts in Tuberculosis Control

¹ Director Emeritus, Chest Disease Bureau, Department of Health, Emeritus Physician in Charge, Tuberculosis Control, Division of Health, Newark

The health department is accountable for isolation and treatment of infectious tuberculosis to prevent spread and protect the community. Control programs, adequite therapy and education will diminish spread of the disease. Modern medical and surgical therapy have contributed to the falling mortality and morbidity. Rapid decline in deaths cannot be interpreted as evidence of approaching eradication when the slow drop in the case rate is considered. Ambulatory patients have increased not as a result of more rapid discharges from sanatoria, but due to the majority being under the care of physicians in private practice. Control procedures are still far from satisfactory. The intracutaneous (Mantoux) test has proved far better and more economical than mass x-ray surveys. Tuberculin testing should not be restricted to schools, but also utilized in pre-school children and in controlled groups of adults. Annual testing of the negative reactors will locate recent convertors. The diminishing rate of positive reactors empphasizes that eradication must depend on the absence of infection. The majority of patients now consist of the aged, largely the result of reactivation of lesions that began years ago, usually in childhood. With failure of infection in early life, there will be no arrested pathology to break down as one grows old. Incorrigibles must be isolated and committed to an institution until non-infectious. Unknown, undiagnosed and untreated cases continue as the greatest source of spread of infection.