Tuberculosis control in California mental hospitals.

Diagnosis, the first step in tuberculosis control, is accomplished in the mental hospitals of California by x-ray examination of all patients annually and of new or returning patients on admission. This routine has been carried on since 1937. Tuberculous patients with active disease are segregated in one of three specially staffed and equipped units at the Patton, Sonoma and Napa hospitals. Those in whom disease is likely to recur are likewise segregated for special care and observation. Those in whom disease is inactive or not definitely diagnosed are not segregated but are observed by physicians of the Bureau of Tuberculosis Control of the California Department of Public Health in collaboration with the staffs of the institutions. Since the establishment of this program the proportion of new or previously unrecognized cases of tuberculosis has been reduced from 0.83 per cent, a year after the program was begun, to 0.37 per cent, while recurrence or progression of previously recognized disease has been reduced from 12.3 per cent at the first survey to 5 per cent at the most recent. Overcrowding in all hospitals has been the chief obstacle to the success of the program.