Tuberculosis Undefeated

I account it a great privilege to be asked to give this lecture in memory of my friend Marc Daniels.From him I first learnt about the epidemiology of tuberculosis and much about the scientific approach to its study.But.for him, tuberculosis was not merely an intellectual interest.He had a passionate concern for the welfare of the men and women behind the facts and figures.It was this underlying passion, coupled with a high and sane intelligence, which enabled him to contribute so much in this field in the course of his short life.First of all I must excuse the somewhat sententious title of my lecture.I believe that we now have the weapons to defeat tuberculosis finally and completely, but that we could be using these weapons more exten- sively, more intensively, and more intelligently than at present.In economically developed countries we have certainly made progress, but might not this progress be much more rapid ?In this lecture I intend to review the weapons at our disposal and make some suggestions about their better use.The World Health Organization calculates that at the present time between 0.5 and l % of the world's popula- tion are coughing up tubercle bacilli (Holm, 1959).That is to say, there may be 12 to 25 million infectious cases throughout the world.An estimate based on a large- scale sample survey (Indian Council of Medical Research, 1959) suggests that in India alone there are four to eight million active or probably active cases.Logan and Benjamin (1957) calculate that in England and Wales there are probably about 375,000 cases of respiratory tuberculosis, of which about 45,000 are infectious.Confronted with such an astronomical computation of distress, it is clear that tuberculosis is very far from being defeated, even in economically developed countries.Indeed, in underdeveloped countries it is often said that