Tuberculosis Case Finding in Institutional Populations—The Use of 35 mm. Fluorograms Among the Mentally Ill

Abstract

A portable and inexpensive fluoro-graphic unit, using 35-mm. film in a standard camera and transportable 200-milliampere x-ray equipment, was tested in a State hospital for the mentally ill. Of the > 1200 patients, all of whom were tested, few could cooperate and many were deformed and otherwise physically not good subjects; yet the apparatus was efficient in discovering a very large proportion of the advanced cases of tuberculosis in the population. Over 150 cases of tubercolosis, in addition to the 66 known before the expt., were identified in the course of these studies. The readings of small films were checked against independent interpretations of corresponding standard x-ray plates, with the result that the errors of both over- and under-reading were found. In neither respect was the lack of correspondence great enough to cause concern about the essential accuracy of the technique as a screening device, even among uncooperative subjects. The results of the expt. indicate that the technique and apparatus used are, even without further refinement, sufficiently accurate to warrant their widespread adoption by States for use among institutional populations, particularly if the State has a number of such large institutions. Routine "screening" or identification of communicable cases of tuberculosis and periodic rechecking of suspicious cases would then be possible at a small fraction of the cost of using standard 14" X 17" x-ray film equipment. If also segregation and treatment were further centralized, the advantages to the patients themselves, the institutional employees, and the general public would be very important, not only from the point of view of communicable disease control but also from that of substantial economy.