An Experiment in the Control of Tuberculosis among Negroes

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^T HE most important tuberculosis problem at present is the control of the disease among Negroes. In 1939-1941 the death rate among nonwhite persons in New York City was 208 per 100,000 population, compared with a rate of 41 among white persons (7). It is generally recognized that most of the Negro population in any given community are living on the lowest economic level. This implies environmental conditions associated with poverty, poor housing, and inadequate income for food, clothing, and other necessities. Since tuberculosis mortality does vary with the level of living of groups of the population, and since nutrition is an important environmental factor determined to a considerable extent by the level of living, it seemed important to conduct an experiment to learn whether an improved nutritional status and by implication a higher level of living will affect the incidence of tuberculosis among persons at risk of attack because of exposure in the family. This particular experiment was conducted in Negro families in Harlem. The importance of environment when considering tuberculosis has been brought out by various persons interested in the subject. Frost (8) said: Probably nothing has been more influential in bringing about the decline of tuberculosis than progressive improvement in the social order as a whole; and nothing, perhaps, is more essential to the further effective control of the disease than to hold up, and so far as possible to improve the standards of living of the lower economic strata. ... It is probable that one of the most important factors in the decline of tuberculosis has been progressively increasing human resistance, due to the influence of selective mortality and to environmental improvements such as better nutrition and relief from