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needs to be carefully reassessed. In this connection we have
recently started in conjunction with the various Metropolitan
Mass X-ray Units, a survey of the inhabitants of common
lodging houses and similar institutions to determine the attack
rate in such communities. It is hoped it will be possible to do
similar surveys throughout the whole country in order that an
estimate of the size of this population may be made and, more
important, that the particular individuals found to have tuberculosis
should realise the benefits of adequate treatment once
they have been diagnosed.
Tuberculin testing of all children attending Child Welfare
Clinics has been continued and those with positive reactions are
referred to the Chest Clinic; in this way a number of cases of
pulmonary tuberculosis have been found. The London County
Council have been giving B.C.G. vaccination to all suitable
school-leavers, and as the result of preliminary tuberculin testing
a number of positive cases have been referred to the Clinic.
Usually they were already known as contacts of notified cases
but in many instances it has been found either that the child
has evidence of an active lesion or it was possible to find the
primary infecting source case. We feel that this system of
tuberculin testing is a most valuable means of case-finding and
also reflects the degree of tuberculous infection in the community.
It is desirable, therefore, that the scheme of tuberculin testing
should be extended to other age groups in the schools.
B.C.G. vaccination has been given to 201 children. This
is a very small number but this is due to the fact that, at present,
B.C.G. vaccination is restricted to certain age groups. I feel
that as B.C.G. vaccination has been shown in this country to
afford a high degree of protection against tuberculous infection
it should be available to all. It is not, of course, the answer to
the problems of tuberculosis, but it is one of the more useful
weapons in the fight against this disease.
The original function of the Tuberculosis Dispensary was
to be a centre from which the struggle against tuberculosis could
be directed but with the shifting emphasis of the disease and the
increase in other respiratory infections, the work has become
much more widespread. A large number of cases of chronic
bronchitis and carcinoma of the lung are now seen at the Chest
Clinic. It should be noted that while the deaths from bronchitis
totalled 171 compared with 241 from coronary artery disease
which heads the mortality table, 114 deaths from carcinoma of
the lung (an increase from 80 in 1954) occurred, i.e., almost three
and a half times the death rate from tuberculosis. It is possible
that a number of the deaths attributed to bronchitis or pneumonia
may hare had an underlying carcinomatous lesion. Ten and a