TUBERCULOSIS (PULMONARY) (a) Infective Agent.—Mycobacterium tuberculosis, most com monly the human strain.
(b) Source of Infection.—Typical or atypical cases.
(c) Exit of Infective Agent.--The most important portal of exit is by means of the sputum. The bacilli may also leave the body in the discharges from the intestinal and genito urinary tracts, or in discharges from lesions of the lymphatic glands, bone and skin.
(d) Route of Transmission.—By direct and indirect contact.
(e) Incubation Period.—Prolonged and variable, depending upon the type of disease.
(f) Period of Communicability.—Commences when a lesion becomes open and continues until it heals or death supervenes. It is of var'abl_e duration though usually prolonged.
(g) Entrance of Infective Agent into Body.—By the mouth or the nose, passing either directly to the lungs by the inhalation of the organisms, or by way of the upper thoracic lymphatic system; or by ingestion of bacilli from the intestinal tract, passing from thence to the lungs by the lymphatics. Appar ently infection takes place in early life, prior to the age of ten. The disease then remains latent until several years later, until adolescence or early adult life.
(h) Methods of Control. The Injected Individual.—i. Diag nosis: By clinical manifestations and bacteriological examina tion of the sputum.
2. Isolation: Only of such open cases that do not observe the precautions necessary to prevent the spread of the disease.
3. Artificial Immunization: None.
4. Quarantine: None.
5. Concurrent Disinfection: Of the sputum and of articles contaminated therewith.
6. Terminal Disinfection: Cleaning and renovation of the occupied quarters.
General Measures.-1. Education of the public regarding the dangers of tuberculosis and the necessary measures for its prevention and control, with special stress laid upon the dangers of exposure and infection in early childhood.
2. Provision of dispensaries and visiting nurse service for the discovery of early cases, and the supervision of home cases.
3. Provision of hospitals for the isolation of advanced cases and of sanitaria for the treatment of early cases.
4. Provision of open-air schools for pretubercular children.
5. Improvement in housing conditions, particularly dealing with overcrowding, inadequate lighting and ventilation, as well as improving the nutrition of the poor.
6. The ventilation and elimination of dust in industrial establishments and places of public assembly.
7. Improvement in the personal hygiene of the public, parti cularly preventing promiscuous expectoration, and a betterment of the general living conditions.
8. Separation of babies from tuberculous mothers at their birth.