DOWN BUT NOT OUT

Abstract

UNLIKE player pianos and Stanley Steamers, tuberculosis is still not a thing of the past. What has happened to the Rose family in the past few years shows why public health workers continue to strive to control the spread of tuberculosis. Redmont may not be the prettiest or sunniest town in California, but it is home to the Rose family-and they like it. The youngest members of the family Warren, Kay, and Larry, 12, 11, and 9 years old respectively, offer no more than the usual complaints about school, and welcome weekends and vacations. Helen, who is 21, likes her job with the telephone company, and 22-year-old Bill, who has become man of house also works. Mrs. Rose does her best to be a good mothershe is often a little sad that her husband did not live long enough to see his children grow up. This was the Rose family when I first knew them. They appeared to be a healthy, happy, fun-loving family. But, the three youngest children had all been hospitalized with active pulmonary tuberculosis and Mrs. Rose had only recently been discharged from a sanatorium. Even now their every activity is geared to a process of living with, or rather in spite of, TB. What was the story five years ago? Mr. Rose was alive at that time but was unable to work because of a chronic heart condition. Warren and Larry were hospitalized because of a fever of unknown origin. At this time the family became known to the local health department and the public health nurse was asked to visit them to obtain necessary epidemiological information. The data she obtained led the doctor to suspect tuberculosis. The chest x-rays of the entire family showed that both boys and Kay had primary tuberculosis, and that Mr. Rose had several calcified areas in his lungs. After several months in the hospital, the children were sent home on a regimen of complete rest. Within a year they all had exacerbations, and had to be rehospitalized. In the meantime Mrs. Rose's chronic asthma became more and more of a problem. Each year it was necessary for her to have an extensive series of antigen injections; many of these were given in the home by the public health nurse. By fall the children were all back in school on restricted activity schedules. Mr. Rose suffered a fatal heart attack, and Mrs. Rose was left with the responsibility of bringing up the family. Throughout this 5-year period the family had routine x-rays and checkups. At the end of that time Mrs. Rose's chest x-ray showed some suspicious shadows. Although her sputum cultures were negative, the doctor thought that she had a small cavity and she was admitted to the sanatorium for a period of rest and treat-