486 § ANNUAL REPORT SMITHSONIAN INSTITUTION, 1944 
6. Relocation in areas of intense war-industry activity where tuber- 
culosis rates may be high by persons coming from areas where tuber- 
culosis rates are low. 
7. Congestion in concentration camps, war prisoners’ camps, evacua- 
tion depots or camps, and air-raid shelters. 
8. Use of hospital beds formerly allocated to the tuberculous for 
more urgent war needs or actual destruction of hospital facilities by 
the bombings or bombardments of “total” warfare. 
9. Loss of trained personnel to the war need—physicians, nurses, 
attendants, laboratory workers, and social workers—all needed to care 
for an increasing load of tuberculosis patients. 
10. Food shortages, both qualitative and quantitative. 
11. Impossibility for perfect rest conditions so necessary for the 
tuberculous and the pretuberculous. 
12. Worry and anxiety over the fate of one’s relatives or even of 
one’s country. 
One of these points deserves particular emphasis as far as this 
country is concerned. As pointed out in an editorial in the New 
England Journal of Medicine for January 27, 1944, “it is estimated 
that 25,000 had been diagnosed (at induction) to have a disease that 
neither they nor their friends would have suspected under prewar 
conditions. And how are these patients, many of whom need sana- 
torium treatment, going to be accommodated by the currently re- 
stricted personnel of the sanatoriums?” Early in 1942 the number of 
beds for tuberculosis patients in this country totaled 97,726, or 1.62 
per annual death, which is at best well below the minimum standard 
set at 2 beds per annual death and far below the more ideal standard 
of 3. In 1942 only seven States and the District of Columbia had met 
the minimum standard. It is quite possible that under present con- 
ditions of personnel shortage the paper figure of 97,726 beds available 
for tuberculosis patients must be considerably discounted. Where 
fighting is actually going on the condition is, of course, much worse. 
Just what has happened thus far in the present war? Hilleboe 
states that by the last half of 1942 in the United States the Bureau of 
the Census, by a sampling process, had sensed an increase in tubercu- 
losis in the “critical areas,” although the total figure for 1942 repre- 
sents an all-time low rate of 43.1 per 100,000. In England he notes a 
13 percent increase in deaths from all forms of tuberculosis in 1941 
as against 1938. This represents more than 3,000 additional deaths 
each year from a preventable disease. Recently in the British Medi- 
cal Journal (January 8, 1944) it is stated that in Belgium the regis- 
tered cases of tuberculosis increased from 69,079 in December 1941, to 
109,511 in February 1943, an increase in rate from the high figure of 
§30 per 100,000 to the startling figure of 1,330 per 100,000. If there 
