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it will be replaced by a living vaccine, which will give more
lasting protection, and which can be taken by the mouth.
This vaccine will correspond to B.C.G. in that it contains living
organisms which as a result of repeated culturing are no longer
able to produce the disease in man, but nevertheless have a very
high power of protecting him against attack.
Tuberculosis.
B.C.G. vaccination against tuberculosis has been given to
millions of people throughout the world during the past ten
years. In some countries it is compulsory for all newly born
children and other age groups to receive it. Caution has been
the keynote in this country, because scientific proof of its value
is only just being obtained. At present it is given to child
contacts, children leaving school and specially exposed groups
such as nurses. In Camberwell last year 201 persons received
B.C.G. Vaccination at the Camberwell Chest Clinic, and the
London County Council carried out 1,399 B.C.G. Vaccinations
of 13 year old schoolchildren.
There is a body of opinion in favour of a much wider use of
B.C.G. in this country, particularly its extension to school
children of all age groups and this view is fortified by the recent
report of the Medical Research Council on the protective value
of B.C.G.
In many countries, B.C.G. is compulsory for certain age
groups but generally the conditions are more primitive than here
and tuberculosis control schemes are not as efficient. In
countries like our own in which risks of infection are steadily
diminishing, there is some doubt as to whether wide-spread
vaccination would materially infuence the falling death rate.
Nevertheless, the unknown reservoir of infection remains
considerable and from it many young persons continue to be
infected. There is a danger also that vaccination would minimise
the need in the public eye for continuing to pursue other equally
important, and well established personal preventive measures.
A greater use of the Mass X-Ray units and regular medical
examination are of the utmost importance, as is also the testing
of all children at intervals to see whether they have been infected,
and when evidence of this exists, to search for the infecting
case. This has been the practice in Camberwell for some years,
and as a result a large number of hitherto unknown cases have
been brought to light. These include shopkeepers, neighbours
and visiting relatives with coughs and "bronchitis." One of
the most important aspects of tuberculosis at present is the
prevalence of the disease among males of 50 and over; they
often (and quite unknowingly) are the reservoirs of child infection.