The Detection of Early Tuberculosis in Detroit

¹ Detroit, Michigan

Early tuberculosis may be divided into two groups—symptomatic and asymptomatic.

Thorough examination, including tuberculin test x-ray procedures should be carried out immediately in all patients presenting themselves with suggestive symptoms.

If symptoms are present and persist, a negative tuberculin test should not be depended upon, an x-ray being indicated before a negative diagnosis is made. It is further advisable to re-x-ray the lungs after a reasonable time should the first reading fail to show pathology.

If the diagnosis of tuberculosis is considered only in those with suggestive symptoms, a large per cent of cases are missed. This also occurs if one depends entirely on abnormal physical signs or on a contact history.

A positive tuberculin test during the first two years of life, especially the first 12 months, generally means active tuberculosis. For the age period three to five years, a positive tuberculin calls for an x-ray, repeated at intervals though negative if there are any symptoms or if there remains in the household a source of infection. The school age period 6 to 14 years has comparatively the least amount of active tuberculosis. From 15 years upwards the reinfection type begins to appear more frequently. It is the more serious form and is mainly responsible for the spread of this disease.

For the detection of early tuberculosis, therefore, the general public, particularly in the age group 15 to 35 years, should be x-rayed with or without a preceding tuberculin test and irrespective of whether there are symptoms or abnormal physical signs. This applies especially to adolescents and young adults applying for high school and college teams, and to all who work regularly to even a mild degree of exhaustion either because of type of work (physical or mental) or because of the number of hours so engaged.

A higher rate of tuberculosis is found in the poor sections of large cities and where there is usually overcrowding. Where the area served by the physician is inhabited chiefly by unskilled labor he can expect to find the death rate from this disease eight times as high as among professional workers.

It is necessary for the detection of early tuberculosis that the services of a roentgenologist be made available to all physicians for both their pay and non-pay patients.

Finally, the inactive disease cases may become active if not properly advised and kept under observation. It is the writer's studied opinion that these patients will be better served under direct control of the family physician. Accordingly, it is advisable for the general practitioner to familiarize himself with inactive tuberculosis, especially early cases. The care of such patients is well within the general practitioner's field providing he is supplied with periodical x-ray interpretations.

Recommendations—In many small communities there is a lack of x-ray facilities, thus handicapping the local physicians in the diagnosis of early tuberculosis. Since the most important single factor of a successful program is the x-ray, it is suggested that the local county medical societies investigate the needs of communities and present a plan to the proper administration authority through the health officer. The cooperation of local or nearby roentgenologists is usually assured on proper financial arrangements. Whether the purchase of an x-ray machine is necessary can be readily decided. In very small or sparsely populated areas, the roentgenologist can use a portable machine to advantage and within the financial capacity of the area served. Under any circumstances, local physicians cannot be expected to diagnose early lesions unless a roentgenologist's service is available. The cost of this service is reasonably chargeable to the community when the local physician certifies inability of the patient to pay.