1.2. In the beginning

1.2.3 Measurement of TB problem

Even though India was a forerunner in inducting chemotherapy, paucity of funds was a real issue. The sheer inaccessibility of the vast number of patients posed problems of unmanageable proportions. The belief that TB was more urban oriented and concentrated in industrialised pockets could be well founded but was not proved. Data from tuberculin surveys conducted from 1930 onwards indicated that 75% of the population living in industrialised cities, above the age of 15 years were tuberculin positive. However, in reality such surveys had not been carried out in rural areas. What was the prevalence of infection in rural areas? Soon evidence began to pile up to the contrary by way of mass BCG Campaigns. The tuberculin testing done on a mass scale prior to BCG vaccination for 27,95,904 persons in 18 different parts of India during 1948-49, yielded some results. Dr Benjamin concluded in 1950, that the tuberculous infection is so widespread that no part of the country is free from it25. The subsequent BCG campaigns revealed similar findings. However, this needed to be checked by scientifically conducted surveys. From 1938, surveys were conducted in many parts of India by motivated TB workers, e.g., Dr Benjamin, 1939; Drs PC Ukil and Sahani, 1941; Dr Aspin, 1945; Dr Frimodt Moller, 1949; Drs Sikand and Raj Narain, 1952. However, different workers had their own survey plan, methodology and target group such as police, gurkha regiment and labour units. Each survey yielded valuable information and indicated a very high morbidity (sickness) rate, from 2.3 to 7% of the population studied. These failed to provide adequate information for estimating the incidence of TB in the general population. In 1952, Dr Frimodt Moller conducted a survey in a rural population of 34,000 persons living in 175 villages around Madanapalle, south India. The mortality rate in this group was 0.42% and tubercle bacilli were demonstrated in 0.24 %26,27.