Death from Neglect

Medical scientists now have both the knowledge they need to wipe out tuberculosis as a public-health problem and the tools to finish the job. In the U.S., at least, with plenty of space for its people, resources to house and feed them decently, and wonder drugs by the carload, the TB victim these days dies not so much from his disease as from neglect. Last week health and Government officials in Alabama were in distress as they faced up to the fact that, although their state runs an energetic TB detection campaign, it lags sadly in preventing the disease and caring for patients.

It is not only that Alabama is relatively poor. So is, or has been, many another Southern state. But some, such as North Carolina, Tennessee and Georgia, have done a first-rate job of checking and treating TB. Not so Alabama. Alone among the states, it imposes no statewide rules for the care of patients and assumes no overall responsibility for them. It has appropriated only $450,000 for their care this fiscal year, as against $2,650,000 for Tennessee and $3,137,000 for Georgia.

Negroes' Plight. Alabama has 11,500 known cases of tuberculosis, of which no less than 3,000 were newly reported in 1952, and an estimated 8,000 more cases undetected and unreported. Each year it has 600 TB deaths, many among back-country folk who did not know they had the disease. But even if their cases had been detected, they would have been little better off: for TB patients, the state has only 720 beds (some of them in tumbledown shacks dating from 1924). By the most conservative standard, it needs at least 1,000 more beds. Negroes, with less resistance to the disease, need hospitalization more urgently than whites, but a Birmingham Negro may wait a year for a segregated bed as against six weeks for a white man.

An Alabama hospital bed carries with it no assurance of adequate care. The state's funds work out at about $1.80 a day for each patient. Local and voluntary moneys boost the total to $4.50, whereas in hard-pressed Mississippi the total is $6.24, and in Tennessee $10. Only three of Alabama's eight sanatoriums are equipped for surgery, and some give streptomycin and isoniazid only to patients who can pay for them. One 65-bed hospital has no registered nurse; a practical nurse does her best with unskilled help.

Under sharp prodding by the Alabama Tuberculosis Association, with eloquent backing from the press, tax-conscious Governor Gordon Persons and the legislature saw that Alabama's penny-wise policy was pound-foolish. The best they could do was to promise to try to find $500,000--somewhere. But every dollar that Alabama "saved" by not spending it this year would mean tens of dollars to be spent in future years on neglected cases, and many a life would be lost. From more than one county came reports of women awaiting admission to a sanatorium and, to support themselves, minding children, thus passing on the white plague to them.

Compare the Cow. Other states have recently faced the same problem as Alabama, and have gone far toward defeating it. Pennsylvania, rich, but with many pesthole slums, cut its lung-tuberculosis death rate from 37 per 100,000 in 1945 to 16 in 1952. Though this was the period when streptomycin worked its greatest wonders, Pennsylvania laid the basis for continuing betterment. More unsuspected cases are being found through mass X-ray programs, and 36 centers for surgical treatment have been set up. Vaccination with BCG is being tested. However, Pennsylvania still needs nearly twice as many beds as it has (3,902) for TB patients.

Without drugs, tuberculosis in cattle was stamped out in a quarter-century. Human tuberculosis can go the same way, and sooner, if people get as much attention as cows.

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