The Induction Film as an Aid in Appraising Subsequent Pulmonary Lesions

Abstract

The important problem of tuberculosis in the Army is the discovery of the minimal lesion that exists without symptoms. This problem has long been recognized and was especially emphasized by experience in the first World War (1, 2, 3). The Selective Service Act which was passed by the Congress of the United States in September 1940, therefore, not only required the registration of all young adults for military service, but with its passage the Mobilization Regulations 1–9 as of Aug. 31, 1940, were put into effect. Upon the recommendation of a subcommittee on tuberculosis of the General Committee on Medicine of the National Research Council, these regulations required that every potential soldier be completely examined. This examination included a thorough physical check-up, and an x-ray study of the chest was recommended. Although the regulations then did not require chest roentgenography as a routine part of the examination of the inductee, they did define in detail the general character of minimal or arrested lesions demonstrable by x-ray that would be permissible under Class 1-a. On Oct. 28, 1940, a directive from the Adjutant General's Office of the United States Army provided an opportunity for local agencies to set up and operate roentgenographic services for inducted men. These agencies were to be compensated by the Government until such time as the Army could assemble its equipment and take over the responsibility (4). After Jan. 1, 1941, the Army assumed the full responsibility for roentgen-ray service in induction centers (4). The Surgeon General's office then indicated that the Army was committed to routine roentgen examination of all recruits at induction centers. Paragraph 51, Section XIII, MR 1–9 states: “The chest examination will include a roentgenogram, as well as the usual methods of physical diagnosis. A pertinent history of past chest diseases will be taken. Because of its importance and frequency, special consideration must be given to the detection of tuberculosis” (5). At no time in the history of any country has there been such a definite program requiring examination of all young, supposedly healthy males for the exclusion of one specific disease. Small and isolated communities have promoted such programs to demonstrate methods for the control of pulmonary tuberculosis but, except for their individual findings, these programs were of little value except to stress the fact that routine x-ray studies of the chest were of the greatest importance. The best way to detect latent chest lesions is by roentgen examination. At least 75 per cent of early active tuberculosis can be discovered only by this means (3). About 1 per cent of the male population of military age has active tuberculosis, most of which can be detected only by x-ray examination (3).