The Natural History of Tuberculosis in the Human Body: X. Prognosis among Students with Tuberculin Reaction Conversion before, during and after School of Nursing

Abstract

Of 3,192 graduates of three private hospital schools of nursing, 91.9 per cent were traced. The 68 who died from nontuberculous conditions and the 289 who were not located were followed medically for 1,374 and 8,734 person-years respectively before death or at the time of last contact. The 2,835 traced survivors were followed medically for 61,501 person-years. This study was devised not only to determine extent of a serious tuberculosis situation, but also to try to solve the problem. Prophylactic measures consisted of: a) examination of all hospital patient admissions and personnel; b) communicable disease technique wherever tuberculous patients were treated; c) the tuberculin test on all admissions to school with periodic retests on all non-reactors; d) periodic roentgenograms of chests of all tuberculin reactors; e) an educational program to provide information on all aspects of tuberculosis. When these prophylactic measures were well under way, the percentage of reactors on graduation began to decrease. These measures have been continued with the result that in school I in the class of 1965, 1966 and 1967, none had tuberculin conversion as students. In school II among the 602 students in the classes of 1966 and 1967, tuberculin conversion occurred in five. In school II among the 5,637 in the classes from 1954 through the spring of 1967, conversion occurred in three students. Among the 1,323 students who reacted to tuberculin on admission, or converted while in school, or after graduation, 35 (2.8 per cent) subsequently developed clinical pulmonary lesions, one had renal disease and ten pleurisy with effusion. No student developed tuberculous meningitis of miliary dissemination. Among the 14 who converted while in school, eleven did so before 1935, two in 1943 and one in 1944. This study exemplifies the fact that as long as one or a few react to tuberculin a tuberculosis problem exists. For example, in school I the only clinical cases since 1935 occurred in 1963. In school II the only such case since 1935 occurred in 1967. In school III the only one since 1939 was in 1956. It was the continuation of the routine protective measures which discovered these cases while they were minimal and required very little treatment. The methods employed in this study provide for no compromise with the tubercle bacillus. They protect nurses against invasions of tubercle bacilli so they maintain the same status of freedom with which they were born. To allow tubercle bacilli to invade human bodies is to lose many battles.