The non-cooperative patient.

Two questions come to mind whenever one discusses the problem of the non-cooperative patient, first: Is the management of such a patient an important item in general tuberculosis control? and second: Is a compulsory hospitalization law necessary? Tuberculosis is a contagious disease. The most important single method of prevention is the isolation of the infectious individual from contacts. This isolation can be accomplished by confinement in the sanatorium or the same results obtained by exercising proper precautions in the home away from the sanatorium. When open cases of tuberculosis are permitted to roam the community at will doing such things as attending theatres, movies and athletic contests, promiscuous shopping in stores, mingling with crowds, riding in public conveyances, and living in the same house with children, then an ample supply of fresh cases will always be assured-and the Superintendents of Tuberculosis Hospitals will never have to worry about unemployment. In the past the most fruitful source of pulmonary tuberculosis was the unknown case. With the continuation of community wide x-ray surveys and other case-finding methods, the unknown case promises to dwindle in importance and then the guilt will rest almost solely on that small group of non-cooperatives. In the city and county of Peoria during 1948 it was found that there was an average of 124 known contagious cases of pulmonary tuberculosis. Seventy seven of these or 62 per cent were isolated in hospitals. The remaining were out of the hospital. Of these, 20 were confined in their homes under supervision following prescribed precautions. Twenty-seven, or 21 per cent were out of the hospital, either In their homes, or roaming the streets refusing to cooperate and using few or no precautions toward spreading their disease to others. It is this small residual of patients that will certainly account for the majority of new cases. In Columbus, Ohio a study was made of 150 non-cooperative patients with pulmonary tuberculosis. The results were published in the Ohio State Medical Journal for May 1942. All these patients had a fair to good chance of getting well when the diagnosis was