490 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1944 
It will be seen from figure 3 that five different agencies must be 
integrated in the program. ‘These are the tuberculin-testing group, 
the X-ray group, the chest-physician group, the laboratory group, 
and the sanatorium group. Coordination is best effected by that 
agency having most student contact, which in our institution is the 
tuberculin-testing agency represented by the writer. When there is 
sufficient interest in the program on the part of the coordinator the 
cooperation of the other agencies is easily obtained and cheerfully 
given. In addition to the value of such a program to the health of 
the student body the tuberculosis case-finding program is an admirable 
laboratory experiment in preventive medicine. 
When it was realized that exposure to open cases of tuberculosis had 
to be considered as an important factor in the etiology of the disease 
it was only natural that thought turned to medical personnel—phy- 
Siclans, nurses, hospital attendants, and students of medicine and 
nursing—as persons having an industrial hazard with respect to 
tuberculosis. Three examples will illustrate the validity of this 
assumption. Diehl and Myers reported in 1940 that at Minnesota it 
had been possible to check effectively on the careers of 1,673 of 1,894 
medical students graduating from 1919 to 1936. Among these there 
were 107 cases of tuberculosis, 5 occurring before college, and 47 after 
college. It was found that 46 deaths had occurred among the 1,673, 
of which 11 had been from tuberculosis. 
Again it is well known that inmates of our mental hospitals form 
a group among whom tuberculosis is especially important. A recent 
study of such individuals in New York revealed that on the average ~ 
tuberculosis deaths in such groups in this State were relatively twelve 
times more numerous than for the State as a whole. In certain such 
institutions in this country where careful case-finding programs have 
been carried out on the attendants, rates of infection and actual evi- 
dence of disease much higher than occurs for other individuals in the 
same area have been found. 
Thirdly, the early experience at the University of Pennsylvania 
revealed the significance in that institution of tuberculosis for medi- 
cal students. Less than 10 years ago among 514 Pennsylvania stud- 
ents 5.8 percent of significant tuberculosis was found. Happily, re- 
sults in most other schools are much better, and in fairness to Penn- 
sylvania it should be pointed out that subsequent studies there have 
revealed a very much lower rate. Nevertheless, there seemed to be 
much logic to the statement made in 1930 by Stiedl of Trudeau when 
he said: “Tuberculosis might be called an industrial hazard for the 
medical profession. It is the most important chronic disabling dis- 
ease for the medical student, the young physician and the nurse.” 
