Modern management of tuberculosis; the public health implications of recent advances.

Modern treatment for tuberculosis has greatly increased the problem of preventing spread of infection. BCG vaccination, for instance, would cause all persons to react to tuberculin test so that the possibility of tuberculosis could never be ruled out by this means. Streptomycin and more recently developed drugs may sterilize sputum so that diagnosis cannot be confirmed for some time after use of such drugs; when by use of these drugs the disease had been confined to caseous encapsulations, later breakdown of the encapsulations may release strains of bacilli resistant to the drugs both in the patient and in others infected with them. The temporary sterilization of sputum, coupled with the euphoria resulting in part from abrupt remission of the toxic state, may lead to premature discharge of patients from sanatoria and further spread of tuberculosis. Both the public and the profession must be impressed with these facts.For more profitable than minifilm surveys of normal populations are routine x-ray examination of all patients admitted to hospitals (by which two to five times as many cases have been found) and follow-up of persons who have had contact with tuberculosis patients (thirteen times as many cases found).A study being conducted by the California Tuberculosis and Health Association indicates that in many counties neither the number of x-rays made in public surveys nor the number of cases found is known or even to be estimated from existing records. Because of reduction in deaths due to tuberculosis some public officials are reluctant to spend for further treatment facilities. As the actual number of cases is increasing in many areas, however, expenditures will have to be increased.