As a pediatric problem, tuberculosis has undergone striking change in the past decades, yet few diseases have the complicated interrelationship of personal and community significance that is peculiar to tuberculosis. Management of the tuberculous patient has become largely a matter for hospital and specialized outpatient services, and the individual practitioner has been chiefly concerned with case finding in his own practice. Since the tuberculin test is such an important tool in this respect, the editors thought such a review as presented by Dr. Feldmann of particular importance.
A number of controversial points are touched on. In any public health procedure a routine screening test has value in relation to the proportion of positives likely to result. A test which results in more than 50% positive is not very helpful. On the other hand, a test with one positive in 1,000 is probably too expensive. Dr. Feldmann points out the cogent reasons for routine tuberculin testing and the pediatrician will need to consider these reasons in the light of the conditions in his community and the relevant local and state health program.
Some may be disturbed by the criticism made of the patch test, yet it is important to recognize its limitations. Failure of the patch test to detect all positives has been well known and most pediatricians have thought it useful chiefly as a preliminary test to find the more sensitive reactors.
THE RELATIONSHIP BETWEEN THE TUBERCULIN TESTING, VITAMINS, PASTEURIZATION AND THE PUBLIC HEALTH
