YOUTH INTEREST HIGH IN WAR AGAINST TUBERCULOSIS

By DR. CLEMENT F. BATELLI, M.D., Dr. P.H.

The prevention and control of tuberculosis depends primarily on making an early diagnosis. Discovery of this disease in the early stages not only helps the patient's early recovery, but protects the public health in so far as both the patient and the health authorities are then cognizant of the existence of a contagious disease; and, therefore proper isolation and treatment can be instituted. However, it must be recognized that the diagnosis of early tuberculosis is almost impossible by ordinary clinical means, and one must of necessity resort to x-ray. Up to a few years ago, the cost of an x-ray of the chest militated against this procedure; but with the advent of Photo-Rentgenography, it is now possible not only to carry on mass x-ray surveys, but to do this rapidly and at only a fraction of the cost of the standard 14" x 17" film. Health authorities and experts in the tuberculosis field have found miniature x-ray films very efficient in mass surveys as a screening process in case finding.

The New Haven Health Department has recently purchased a portable Picker Minograph which uses a roll of 70 mm film containing 375 exposures, and can x-ray at the rate of one or more individuals per minute. It is no longer necessary to strip the patient to the waist, and, therefore, this procedure is less embarrassing to the patient and much faster. This x-ray apparatus is entirely automatic, and it is only necessary to place the patient in position and press the exposure button. Automatically the chest of the patient is measured (Morgan Timer), the controls set, and the exposure taken. The exposed films are developed mechanically in special developing tanks.

Members of Health Department Staff demonstrate new X-ray Clinic in action. Clinic is situated in first floor of City Hall at 161 Church Street.

A Chest X-ray Diagnostic Clinic has been set up in the City Hall under the supervision of the Health Department. The tuberculosis control program has been re-organized to take full advantage of this latest advancement in x-ray equipment. New Haven has embarked upon an extensive chest x-ray program in which all contacts wil1 be x-rayed every six months,food handlers every year, high school students annually, and all cases referred by private physicians, including obstetrical patients. Industrial surveys will be done upon request. This entire program with the exception of industrial surveys is free. There will be a nominal fee of twenty-five cents per film for industrial surveys.

With the expansion of the x-ray program, the problem of record keeping has come up. It was somewhat difficult to decide what type of filing system to install, what data to record, and how to keep this up to date. It was finally decided to install an I. B. M. punch card system as this type of file lent itself more readily to statistical analysis. Each person x-rayed will have a punch card made out containing pertinent data identifying the individual. These cards will be numbered and will be filed in numerical sequence. A numerical file instead of an alphabetical one was decided upon, because it was felt that the task of transcribing information and keeping up an alphabetical x-ray file would not warrant the time, effort, and cost. As the contact group presents certain definite problems in follow up and the data for this group are of greater interest, a special alphabetical file will be kept for them.

This is how the x-ray clinic actually operates. John Doe is referred by a private physician for a chest x-ray. He presents his referral slip to the technician at the x-ray clinic, who makes out an identification card (punch card) and addresses two post cards, one to the patient and the other to the referring physician. The post cards are printed and simply state that at the present time there is no pathology of the lungs. The identification card and the post cards are then stamped with the same number and kept in numerical sequence. When the films are developed, both the cards and films are handed to the examiner for interpretation. John Doe's x-ray is then read; and, if found negative, the post cards are mailed out to both the patient and the physician. On the other hand, if there is definite or suspicious evidence of lung pathology, Mr. Doe is asked to return to the clinic to have a 14" x 17" film taken. If on rechecking, the diagnosis is verified, a letter is sent to Mr. Doe notifying him of this fact and advising him to see his physician for further advise and care. His physician is also informed of the findings by letter. This information is then listed on the patient's identification card, and the card filed away.

Once each month, all suspicious or positive films will be gone over by a panel of qualified physicians in order to avoid any mistakes in diagnosis. No patient will be reported as a case of pulmonary tuberculosis unless there is full agreement on the diagnosis. All questionable cases will be referred back to their private physician or to the tuberculosis clinic for further study and diagnosis.

The chest x-ray clinic has filled a great, gap in our program of tuberculosis prevention and control. With this clinic in full running order, this community will be second to none in its modern attack upon tuberculosis. It is conceivable that with the modern, up-to-date facilities for examination and x-ray available to everyone and with adequate financial and public support, tuberculosis can and will be eradicated from our community.

• If it shows that you have a healthy chest, that is good news.
• If it shows that you have already fought a round with tuberculosis germs and have won, that is good news.
• If is shows that you have tuberculosis in the early symptomless stage, that is good news too, because when tuberculosis is found early the chances for complete recovery are excellent provided treatment is started at once.