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Tuberculosis Today
CHEST VOLUME 68 / NUMBER 3 / SEPTEMBER, 1975 (SUPPLEMENT) INTRODUGrION
This special issue of Chest is the second supplement in recent years devoted exclusively to the subiect of tuberculosis. "Treatment of Pulmonary Tuberculosis" was the topic discussed in the June, 1972 supplement. The communications in this 1975 publication stress epidemiologic and clinical aspects of case-finding. A primary theme ichid: appears in hath issues is that diagnosis and therapy of tuberculosis are responsibilities of internists, primary physicians and those in other disciplines in medicine. This "new look" means that many more patients will be treated in the general hospital and in the physician's office. These supplements, therefore, have been directed to a heterogeneous readership.
The emphasis in Ch est on this disease represents the conviction of the American College of Chest Physicians that tuberculosis continues to be a serious challenge. Moreover, it is an international health problem, although the scope and character of the pathologic manifestations vary in different regions. I belieoe, therefore, that the members of the International Academy of Chest Physicians and Surgeons of ACCP will share the appreciation of their American and Canadian colleagues for the authoritative guidelines provided by the contributors to this supplement. Alfred Soffer, M .D.
Editor
Tuberculosis Today As a result of demands for up-to-date knowledge on the status of the problem and on the methods which are available and recommended for tuberculosis control, the American College of Chest Physicians has arranged, with the support of the Lederle Laboratories, to bring together this compendium of up-to-date knowledge on "Tuberculosis Today" as presented by the experts in the field. The basic science of tuberculous infection and immunity is reviewed along with the latest recommendations for classification, diagnosis, screening, and therapy. A number of practical issues are addressed, because the patient must be provided the understanding, motivation, and access to health care necessary to complete the required course of therapy.
The problem of the control of tuberculosis is moving steadily from the responsibility of the official organizations to that of the private practitioner. This is at least partly caused by the following two factors : ( 1) Falling tuberculosis rates have decreased the amount of money available for tuberculosis control. ( 2) There is an increasing press of other programs on the health department. Thus, the shift of the treatment programs from the tuberculosis hospitals to the health departments' outpatient facilities has increased markedly the duties of health department nurses and clinicians; and , of course, the decreased percent of positive tuberculin reactor yield has decreased the yield of contacts to be followed. Also, most health departments' budgets have been declining amid the press of other new programs, such as migrant health, cancer prevention, and accident prevention. In addition , as the yield of positive tuberculin reactors falls, so does the cost of detection rise, and there has been a regrettable tendency to somewhat "ignore the whole mess." On the other hand, the physician, sometimes as the result of tragic experiences , has become interested again in assuming his rightful place in controlling tuberculosis.
Michael L. Eurcoloic, M .D. , F.C.C.P. 0 Lexington, Ky and Whitney W. Addington, ,\J. D ., F.C.C.P . o 0 Chicago
"Professor Emeritus, Department of Community Medicine, University of Kentucky College of Medicine. • ·Chainnan, Department of Pulmonary Diseases, Cook County Hospital.
435
Th:1.s
One
11111 ~IIIIIIIIIIIIIII~ IIII11I1 STOB-263-5D18
This special issue of Chest is the second supplement in recent years devoted exclusively to the subiect of tuberculosis. "Treatment of Pulmonary Tuberculosis" was the topic discussed in the June, 1972 supplement. The communications in this 1975 publication stress epidemiologic and clinical aspects of case-finding. A primary theme ichid: appears in hath issues is that diagnosis and therapy of tuberculosis are responsibilities of internists, primary physicians and those in other disciplines in medicine. This "new look" means that many more patients will be treated in the general hospital and in the physician's office. These supplements, therefore, have been directed to a heterogeneous readership.
The emphasis in Ch est on this disease represents the conviction of the American College of Chest Physicians that tuberculosis continues to be a serious challenge. Moreover, it is an international health problem, although the scope and character of the pathologic manifestations vary in different regions. I belieoe, therefore, that the members of the International Academy of Chest Physicians and Surgeons of ACCP will share the appreciation of their American and Canadian colleagues for the authoritative guidelines provided by the contributors to this supplement. Alfred Soffer, M .D.
Editor
Tuberculosis Today As a result of demands for up-to-date knowledge on the status of the problem and on the methods which are available and recommended for tuberculosis control, the American College of Chest Physicians has arranged, with the support of the Lederle Laboratories, to bring together this compendium of up-to-date knowledge on "Tuberculosis Today" as presented by the experts in the field. The basic science of tuberculous infection and immunity is reviewed along with the latest recommendations for classification, diagnosis, screening, and therapy. A number of practical issues are addressed, because the patient must be provided the understanding, motivation, and access to health care necessary to complete the required course of therapy.
The problem of the control of tuberculosis is moving steadily from the responsibility of the official organizations to that of the private practitioner. This is at least partly caused by the following two factors : ( 1) Falling tuberculosis rates have decreased the amount of money available for tuberculosis control. ( 2) There is an increasing press of other programs on the health department. Thus, the shift of the treatment programs from the tuberculosis hospitals to the health departments' outpatient facilities has increased markedly the duties of health department nurses and clinicians; and , of course, the decreased percent of positive tuberculin reactor yield has decreased the yield of contacts to be followed. Also, most health departments' budgets have been declining amid the press of other new programs, such as migrant health, cancer prevention, and accident prevention. In addition , as the yield of positive tuberculin reactors falls, so does the cost of detection rise, and there has been a regrettable tendency to somewhat "ignore the whole mess." On the other hand, the physician, sometimes as the result of tragic experiences , has become interested again in assuming his rightful place in controlling tuberculosis.
Michael L. Eurcoloic, M .D. , F.C.C.P. 0 Lexington, Ky and Whitney W. Addington, ,\J. D ., F.C.C.P . o 0 Chicago
"Professor Emeritus, Department of Community Medicine, University of Kentucky College of Medicine. • ·Chainnan, Department of Pulmonary Diseases, Cook County Hospital.
435
Th:1.s
One
11111 ~IIIIIIIIIIIIIII~ IIII11I1 STOB-263-5D18