- Email: [email protected]
Complacency in Tuberculosis Control
EDITORIAL Complacency in Tuberculosis Control*
T
HE
FACETIOUS
APHORISM,
"DoN'T
confuse me with the facts; my mind is made up," characterizes the indifferent attitude of many Americans toward tuberculosis. The failure to accept the idea that we are dealing with a public health problem of continuing importance has led to confusion and complacency. It is only fair to say that we will not reach an acceptable standard of tuberculosis control any time soon in the United States, and certainly not in the urban areas, unless everyone concerned recognizes the need for a more aggressive "antituberculosis campaign." This is a matter of special importance to private physicians who play such a vital role in the nation's health program. Perhaps the first step toward solving the tuberculosis problem is to dispel complacency with current facts about the disease, and by repeating the information as often as necessary to maintain a high level of interest. In a nation that only recently responded excitedly when one case of smallpox was admitted to our shores, one sees little concern about the fact that more than 50,000 Americans develop clinical tuberculosis annually or that 10,000 die each year of this disease. In a population of approximately 190,000,000 Americans, almost one-fourth are infected with tubercle bacilli, as evidenced by random tuberculin testing surveys. The fact that at least 5 per cent of these individuals, or 2,000,000 Americans, will come down with the chronic disabling disease of tuberculosis at some time in the future , and -This article was prepared at the request of the Joint Committee on Chest X-ray of the American College of Radiology and the American College of Chest Physicians and is endorsed by the Joint Committee for publication and distribution to the medical profession. This article is a follow-up to the article uTB-The Sleeping Dragon," published in the December, 1962 issue of Diseases of the Chest. Reprints of this article are available upon request.
223
that three-fourths of all new cases found each year come from this group, should spell out the tremendous importance of case-finding by tuberculin and chest x-ray examinations. Needless to say, we are far from the goal of annual tuberculin tests on all negative reactors and the x-ray followup studies on recent tuberculin converters. Since most of our tuberculosis patients are in the advanced stages of the disease when found and more than one-third of the patients with active disease in our country are unknown to public health officials, it is obvious that we have much to learn about case-finding, reporting and registration of patients. Finally, it is a well known fact that specific drug treatment for patients in the communicable stage of the disease is a very important part of tuberculosis control. Unfortunately, the successful use of this modern therapeutic tool is not as well understood as it should be by physicians, and patients often fail to cooperate in the long period of treatment required. It is encouraging to note that the American Medical Association brought many of these deficiencies in tuberculosis control to the attention of its membership during the annual meeting in Atlantic City, New Jersey, June, 1963. A resolution passed by the House of Delegates recognized the importance of this program and urged all members of the American Medical Association and affiliates to support and take part in these important activities. The most important step toward solving the tuberculosis problem in the United States is, of course, the implementation of effective control measures as appropriate for each community. There are many ways in which this can be done, but the entire program will be most successful where physicians work closely with all medical, health and welfare agencies concerned with the problem. The basic responsibility and
Diseases 01
CARL W. TEMPEL
224
authority for tuberculosis control programs belong to the Health Department, but the success of the program depends largely upon the support of the medical profession. In this broad area of responsibility, the physician with special knowledge in chest diseases can do much through his membership in local medical societies and his support of other agencies that deal directly with activities in this area. JOINT
the Chest
The ultimate solution of the tuberculosis problem lies in the development of personal and community responsibility. For the physician, the advice of Doctor Albert Schweitzer is most appropriate, "Example is not the best way, it is the only way." CARL
W.
TEMPEL, MAJ . GEN (RET.)
Chainnan, Committee on Tuberculosis American College of Chest Physicians
COMMITTEE ON CHEST
X-RAY
AMERICAN COLLEGE OF RADIOLOGY
AMERICAN COLLEGE OF CHEST PHYSICIANS
ROBIlRT O. MOSIlLllY, JR., Chicago. Ill .• Cb.i"""" H!luERT L. ABaAws. Palo Alto. Califomia BIlNJAMIN FIlLSON. Cincinnati. Ohio JOHN F. HOLT, Ann Atbor. Michigan JAU.IlLL E. MILLIlR, Dallas. Texas BIlRNA1IIl J . O ·LoUGHUN. Los Angeles. Califomia RUSSIlLL WIGH. ColumbUJ. Indiana
DoNALD R. McKAY, BuHalo, New York. Cb""-,, JOSIlPH N . Acsro, Northumberland. Pennsylvania ROBin J. ANnIlRSON, WashiD&ton. O . C. OTTO L. BIlTTAG. Glen Ellyn . Ill jnois RICHA1IIl G . lISTIlR, Richmond. Virginia JOHN P. MlDIlUIAN. St. Paul ; Minnesota FIlANas J. WBBER. Berkeley. Califomia
EX-OFFICIO
ANDR..... L. BANYAI, Chicago. IllinoiJ JOHN F. BuGGS, St. Paul. Minnesota DAVID S. CADOLL, Memphis. Tennessee HERMAN J . MOIlBSCH, Rochester. Minnesota ROBIlRT O. MOUTON, Fort Worth. Texas EUGIlNIl P. PENDIlRGRASS, Philadelphia. Pennsylvania HIlNRY P. PENDIlRGRASS, Boston. Massach_ CHABLIlS K. PETTIlR, Waukegan. Illinois THBODOU J. WACHO_SIa, Wheaton. minois
mGHLIGBTS FROM COLLEGE INTEBIM SESSION NEWER CONCEPTS IN THE DIAGNOSIS OF MYOCARDIAL INFARCI'ION Or. Stephen R. Elek, Los Angeles, described relatively unknown cllnlcal features of patients who have hIdden myocardIal Intarctlons. The latter Is not synonymous with patients who have atypIcal pain location. but with corroborating laboratory and/or electrocardIographic evidence. In hIdden myocardIal Infarctlon, he pointed out, the symptoms are otten
vague and usually non-dlagnostlc; the SGOT tests are often not abnormal and the electrocardlogram shows nonspecific changes or alterations suggesting only myocardIal IschemIa. EvIdence tor the presence ot myocardial Infarction Is tound In the vectorcardIogram. The practIcal medIcolegal and Insurance aspects ot the syndrome were dIscussed.
EMPHYSEMA OF ONE LUNG ASSOCIATED WITH CONGENITAL CARDIAC ABNORMALITIES Marked emphysema ot one lung assoclated with the absence ot the pulmonary artery to the opposlte lung may dIrect attention toward the pulmonary changes. Two Infants with unilateral emphysema have been studJt'd recently by Or. John R. Derrick. Galveston. in an effort to describe this abnormalIty when assoclated wIth unilateral pulmonary artery atresIa. ThIs anomaly appears to be assoclated with tetralogy ot Fallot more otten than any other Isolated cardiac detect. Most of the cases may be dIagnosed
by a routine x-ray pIcture of the chest, but In questionable cases, partIcularly those In whIch there Is unilateral emphysema, angIocardiography may be
necessary.
The presentation described some ot the common abnormalities of the pulmonary artery assoclated with tetralogy ot Fallot and other congenital abnormalIties. Documentation ot these cases was presented wIth anglocardlographic ftndJngs, x-ray ftndIngs, as weli as results of cardiac catheterization.
T
HE
FACETIOUS
APHORISM,
"DoN'T
confuse me with the facts; my mind is made up," characterizes the indifferent attitude of many Americans toward tuberculosis. The failure to accept the idea that we are dealing with a public health problem of continuing importance has led to confusion and complacency. It is only fair to say that we will not reach an acceptable standard of tuberculosis control any time soon in the United States, and certainly not in the urban areas, unless everyone concerned recognizes the need for a more aggressive "antituberculosis campaign." This is a matter of special importance to private physicians who play such a vital role in the nation's health program. Perhaps the first step toward solving the tuberculosis problem is to dispel complacency with current facts about the disease, and by repeating the information as often as necessary to maintain a high level of interest. In a nation that only recently responded excitedly when one case of smallpox was admitted to our shores, one sees little concern about the fact that more than 50,000 Americans develop clinical tuberculosis annually or that 10,000 die each year of this disease. In a population of approximately 190,000,000 Americans, almost one-fourth are infected with tubercle bacilli, as evidenced by random tuberculin testing surveys. The fact that at least 5 per cent of these individuals, or 2,000,000 Americans, will come down with the chronic disabling disease of tuberculosis at some time in the future , and -This article was prepared at the request of the Joint Committee on Chest X-ray of the American College of Radiology and the American College of Chest Physicians and is endorsed by the Joint Committee for publication and distribution to the medical profession. This article is a follow-up to the article uTB-The Sleeping Dragon," published in the December, 1962 issue of Diseases of the Chest. Reprints of this article are available upon request.
223
that three-fourths of all new cases found each year come from this group, should spell out the tremendous importance of case-finding by tuberculin and chest x-ray examinations. Needless to say, we are far from the goal of annual tuberculin tests on all negative reactors and the x-ray followup studies on recent tuberculin converters. Since most of our tuberculosis patients are in the advanced stages of the disease when found and more than one-third of the patients with active disease in our country are unknown to public health officials, it is obvious that we have much to learn about case-finding, reporting and registration of patients. Finally, it is a well known fact that specific drug treatment for patients in the communicable stage of the disease is a very important part of tuberculosis control. Unfortunately, the successful use of this modern therapeutic tool is not as well understood as it should be by physicians, and patients often fail to cooperate in the long period of treatment required. It is encouraging to note that the American Medical Association brought many of these deficiencies in tuberculosis control to the attention of its membership during the annual meeting in Atlantic City, New Jersey, June, 1963. A resolution passed by the House of Delegates recognized the importance of this program and urged all members of the American Medical Association and affiliates to support and take part in these important activities. The most important step toward solving the tuberculosis problem in the United States is, of course, the implementation of effective control measures as appropriate for each community. There are many ways in which this can be done, but the entire program will be most successful where physicians work closely with all medical, health and welfare agencies concerned with the problem. The basic responsibility and
Diseases 01
CARL W. TEMPEL
224
authority for tuberculosis control programs belong to the Health Department, but the success of the program depends largely upon the support of the medical profession. In this broad area of responsibility, the physician with special knowledge in chest diseases can do much through his membership in local medical societies and his support of other agencies that deal directly with activities in this area. JOINT
the Chest
The ultimate solution of the tuberculosis problem lies in the development of personal and community responsibility. For the physician, the advice of Doctor Albert Schweitzer is most appropriate, "Example is not the best way, it is the only way." CARL
W.
TEMPEL, MAJ . GEN (RET.)
Chainnan, Committee on Tuberculosis American College of Chest Physicians
COMMITTEE ON CHEST
X-RAY
AMERICAN COLLEGE OF RADIOLOGY
AMERICAN COLLEGE OF CHEST PHYSICIANS
ROBIlRT O. MOSIlLllY, JR., Chicago. Ill .• Cb.i"""" H!luERT L. ABaAws. Palo Alto. Califomia BIlNJAMIN FIlLSON. Cincinnati. Ohio JOHN F. HOLT, Ann Atbor. Michigan JAU.IlLL E. MILLIlR, Dallas. Texas BIlRNA1IIl J . O ·LoUGHUN. Los Angeles. Califomia RUSSIlLL WIGH. ColumbUJ. Indiana
DoNALD R. McKAY, BuHalo, New York. Cb""-,, JOSIlPH N . Acsro, Northumberland. Pennsylvania ROBin J. ANnIlRSON, WashiD&ton. O . C. OTTO L. BIlTTAG. Glen Ellyn . Ill jnois RICHA1IIl G . lISTIlR, Richmond. Virginia JOHN P. MlDIlUIAN. St. Paul ; Minnesota FIlANas J. WBBER. Berkeley. Califomia
EX-OFFICIO
ANDR..... L. BANYAI, Chicago. IllinoiJ JOHN F. BuGGS, St. Paul. Minnesota DAVID S. CADOLL, Memphis. Tennessee HERMAN J . MOIlBSCH, Rochester. Minnesota ROBIlRT O. MOUTON, Fort Worth. Texas EUGIlNIl P. PENDIlRGRASS, Philadelphia. Pennsylvania HIlNRY P. PENDIlRGRASS, Boston. Massach_ CHABLIlS K. PETTIlR, Waukegan. Illinois THBODOU J. WACHO_SIa, Wheaton. minois
mGHLIGBTS FROM COLLEGE INTEBIM SESSION NEWER CONCEPTS IN THE DIAGNOSIS OF MYOCARDIAL INFARCI'ION Or. Stephen R. Elek, Los Angeles, described relatively unknown cllnlcal features of patients who have hIdden myocardIal Intarctlons. The latter Is not synonymous with patients who have atypIcal pain location. but with corroborating laboratory and/or electrocardIographic evidence. In hIdden myocardIal Infarctlon, he pointed out, the symptoms are otten
vague and usually non-dlagnostlc; the SGOT tests are often not abnormal and the electrocardlogram shows nonspecific changes or alterations suggesting only myocardIal IschemIa. EvIdence tor the presence ot myocardial Infarction Is tound In the vectorcardIogram. The practIcal medIcolegal and Insurance aspects ot the syndrome were dIscussed.
EMPHYSEMA OF ONE LUNG ASSOCIATED WITH CONGENITAL CARDIAC ABNORMALITIES Marked emphysema ot one lung assoclated with the absence ot the pulmonary artery to the opposlte lung may dIrect attention toward the pulmonary changes. Two Infants with unilateral emphysema have been studJt'd recently by Or. John R. Derrick. Galveston. in an effort to describe this abnormalIty when assoclated wIth unilateral pulmonary artery atresIa. ThIs anomaly appears to be assoclated with tetralogy ot Fallot more otten than any other Isolated cardiac detect. Most of the cases may be dIagnosed
by a routine x-ray pIcture of the chest, but In questionable cases, partIcularly those In whIch there Is unilateral emphysema, angIocardiography may be
necessary.
The presentation described some ot the common abnormalities of the pulmonary artery assoclated with tetralogy ot Fallot and other congenital abnormalIties. Documentation ot these cases was presented wIth anglocardlographic ftndJngs, x-ray ftndIngs, as weli as results of cardiac catheterization.