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THE TECUMSEH COMMUNITY HEALTH STUDY (TCHS) was not undertaken solely as a rheumatic disease survey but as a broad study of health and disease in a total community setting. [l, 21 It was conceived as a continuing dynamic study of the multitude of natural processes and interactions which are responsible for the maintenance of health or the development of disease. Interest has centered not so much on the identification of established disease as on the possibility of elucidating the early origins of disease and identifying those apparently healthy individuals with a predisposition to disease. The focus has been on the family unit and kindred since the working hypothesis has been that if genetic or environmental factors are operative in the production of a given disease then actual or potential viotims should cluster about the identifiable index cases. After careful study the community of Tecumseh, Michigan was selected as the site of (the study in 1957. Tecumseh is located in southeastern Michigan approximately 30 miles from AM Arbor. Its size of 9500 was considered adequate and yet small enough to make an ambitious study practicable. It is located in a rural agricultural area but also has a large manufacturing plant so that a variety of socioeconomic groups are present. Available information indicated the relative stability of the population and a friendly cooperative community spirit was apparent. In 1957 a complete census of the town was undertaken and all inhabitants charted by households and kindreds. Self-reported information was obtained regarding forty chronic health conditions including "arthritis", "rheumatism" and chronic back pain. During 1957 and 1958 several pilot studies, including an investigation of cerebral palsy, a prophylactic trial of influenza vaccine and a study of the relationship between blood group,s and fertility, were successfully concluded. METHOlDS OF STUDY The present phase of the study wlas designed to obtain medical historical information, a physical examination and certain physical and laboratory measurements

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BACKGROUND SINCE 1958, the Atomic Bomb Casualty Commission (ABCC) has been conducting a long-term follow-up investigation (Adult Health Study) [ 1] of large defined population samples in Hiroshima and Nagasaki, Japan. In the course of this program the prevalence of definite rheumatoid arthritis was measured and its incidence estimated, according to observations made upon 16,269 subjects from 1958 to 1964 [2]. The original observations were made during routine medical examinations, not specifically designed to detect rheumatoid arthritis, and with the inherent disadvantages of a retrospective approach. A prospective rheumatic disease study was therefore conducted at ABCC from 1965 to 1967 for the specific detection of rheumatic diseases and to determine age-sex specific prevalence and the incidence of rheumatoid arthritis. It was also intended (1) to define the natural history of rheumatoid arthritis as related to physical and environmental factors; (2) to detect any relationship between A-bomb radiation exposure and the disease; (3) to define the