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Report of the Consultant Physician, Camberwell Chest Clinic.
During the past year the work of the Chest Clinic at Brunswick
Park has continued to increase. The service, which started
in 1952, whereby general practitioners could refer patients for a
chest X-ray report, has led to an increase in the number of new
patients seen. In all, 5,060 persons attended for examination
and investigation because some abnormality was noted in their
initial chest X-ray, or because the general practitioner requested
an examination for a specific symptom.
A study of the age distribution figures for notifications
shows that the danger period for women is still between 15 and
35 years. There were 63 cases compared with 37 in the age
group 35-55, while in men the period comes later. There were
86 in the age group 35-55 and 52 in the over 55 group; this latter
group contained only 17 women. All these figures are in keeping
with the national trend and emphasize the great need for
detecting cases in older persons.
Ante-natal chest X-ray examination is of value in detecting
cases of tuberculosis as the 20-year period 15-35 covers the
child-hearing age. Routine mass X-ray examination of random
populations or of school-leavers is much less likely to yield new
cases of pulmonary tuberculosis than selected examinations of
particular populations such as Reception Centres where a number
of cases of active tuberculosis have been discovered. This
source of infection is one which requires urgent attention.
Furthermore, if more men who have "chronic bronchitis" or
"smoker's cough" were X-rayed, there is no doubt that more
cases of chronic pulmonary tuberculosis in the older age groups
would be discovered.
Another means of case finding is the tuberculin testing of all
children attending Infant Welfare Clinics. When a positive
reactor is found all the ancillary workers, such as health visitor,
school nurse and clinic nurse, are called upon to find the source
case, who may frequently turn out to be a grandfather or uncle,
not always living in the same house. It is hoped that this form
of examination can be extended to annual testing of school
children because it is known that there is a conversion rate of
3 per cent, per annum, and adequate search should yield a high
proportion of source cases.
Contact examination by X-ray of those over 12 and tuberculin
testing of younger members of a family is not only a very
valuable means of finding new cases but it is a very necessary
reassurance for the family. Twenty-one new cases of pulmonary
tuberculosis were found as a result of contact examination at the
clinic.