When I was a school boy, once a year, a big white van would pull into the school yard. We would be lined up, march out of class, and into the van, where a photofluorographic machine awaited us.
“Stand right here. Put your chin against the bar. Spread your arms out. Take a deep breath. Hold it. That’s all. Next person.” A few weeks later, my parents would get a postcard indicating that I had no symptoms of tuberculosis (TB). One year, the postcard said I had a suspicious shadow.
My mother took me to Doc Bushart, our family physician. He had an x-ray machine. Another deep breath. We waited while his receptionist hand-developed the film. “There’s nothing wrong,” he told us. “Most of the people who operate that screening program don’t know what they are doing.” The other years, the postcards were negative.
When I went to graduate school, I got a physical exam as part of my registration. The exam included a TB skin test. A week later, I got a notice that the skin test had been positive. I should report back to the student health center. When I did, they took a chest x-ray. “Can I wait while you look at it?” I asked the doctor. “Come with me,” she said. “I don’t see anything wrong. Probably, when you were a child, you were exposed to someone with undiagnosed tuberculosis and you got a minor infection from it. Any time you have a skin test, it probably will be positive. But you don’t have any signs of TB.”
A decade later, as a staff member of the American College of Radiology, I wrote a press release saying that the ACR had joined the US Public Health Service, the National Tuberculosis Association, and the American College of Chest Physicians in declaring that the scourge of TB had been banished from the United States. There was no further need for population surveys to pick up active TB. Also, development of medication to control TB made it unnecessary to isolate those with positive findings. In those days, most hospitals required a chest x-ray as part of a patient admission process. Admitting an active TB patient to the maternity ward was a bad idea.
Then, and now, American riddance of TB was not shared in many other countries. When AIDS came along, there seemed to be a relationship between the old TB and the new HIV. When migrants came to the United States from countries with TB, the Centers for Disease Control and Prevention continued to take chest exams of aliens seeking to enter the United States. Some hospitals in communities with alien neighborhoods went back to the skin tests or the admission chest films. These examinations were significant for the many aliens who got into our country illegally and minus any medical screening.
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