The Incidence and Prevention of Tuberculosis in American Schools and Colleges.

Summary Reference is made to certain representative studies indicating the trend of tuberculosis in American clementary and high schools, and colleges and schools of medicine and nursing. No attempt has been made to present a complete review of the numerous papers in this field. In the elementary and high schools, studies continued over a decade indicate that the proportion of children positive to the tuberculin test is steadily falling. In the less crowded communities the drop is more striking than in large, congested cities. The incidence in rural communities is generally significantly lower than in urban areas, and differences within the same community are always found corresponding to the economic level. Important tuberculous disease is first met to an appreciable extent in high school students, where the combined incidence of latent and manifest disease varies from 1·5 to nearly 3·0 per cent, being higher among girls. Important disease demanding care occurs in from 0·5 to 1·0 per cent of these children. Active programmes for the early detection and control of tuberculosis in schools now operate throughout the country. The basic principles of these programmes are mass tuberculin testing, x-ray examination of the positive reactors, and provision of suitable care for those found to have lesions. In the colleges, according to an intensive study by the Committee on Tuberculosis of the American Student Health Association, about 6 students per 1,000 have tuberculosis of the adult type, or probably 6,000 students in all American colleges. The average incidence of infection for the country as a whole is about 30 to 35 per cent. A marked variation occurs geographically, students from the great central portion of the country having a relatively low incidence. The programme for control is similar to that operating in public schools, but as a rule more comprehensive, including full-time health departments. Tuberculosis is recognized as the most serious disease of the college period, yet as insidious in onset, requiring routine massmeasures for its detection. It is encouraging that most of the lesions now discovered are in the minimal stage. Students of medicine and nursing are now known to be subject to a special hazard. The danger for medical students seems greatest during the third and fourth, or clinical years, suggesting that tuberculosis acquired in the medical school is usually exogenous. The programme for prevention is similar to that in schools and colleges, but all investigators urge that examinations should be more frequent than seems necessary in earlier years, and radiological examination is regarded as indispensable. Most nurses who are tuberculin-negative on beginning training become positive to tuberculin during their course. The incidence of clinical tuberculosis is also proportionately high as compared with other professional or working groups at the same age, both during the period of training and in the first years after qualification. As with medical students, frequent radiological examination is considered imperative. It is encouraging that, whereas the development of significant tuberculous infection in nurses is frequent, early detection and prompt arrest result from the application of a proper programme for tuberculosis control in the training schools.