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the occupational resettlement of tuberculous persons, London chest physicians are
undertaking on behalf of the medical officer of health the necessary approval and
surveillance of places of employment of persons with open tuberculosis, having regard
to the patient's physical capacity and the risk to the health of others. In view of limited
housing facilities the managements of the village settlements now prefer to admit, for
training, tuberculous persons who have prospects of returning to normal civilian life.
The one London Remploy factory affords only limited facilities for the employment of
83 tuberculous workers. Considerable difficulty is, therefore, experienced in providing
suitable training and employment, especially part-time, for substantially handicapped
and potentially infective tuberculous persons and for this group there is a need for more
sheltered workshops. The Council has for some time considered the establishment of a
sheltered workshop for disabled tuberculous workers, but lack of suitable premises and
the general need for economy have restricted progress.
B.C.G.
vaccination
The Council s scheme tor the B.C.G. vaccination or tuberculin negative contacts
of known cases of tuberculosis was started in September, 1950. The number of contacts
vaccinated by chest physicians under the Council's approved scheme, and, by cooperation
of other local health authorities concerned, by chest physicians of areas in
which children are boarded-out under the Council's tuberculosis contact scheme, is as
follows :
1950 1951 1952
(since Total
September)
Vaccinated by London chest physicians 271 2,287 3,034 5,592
Vaccinated by out-County chest physicians (as
notified by them) 42 220 139 401
In addition, 73 children, the majority of whom were newly-born babies, were
vaccinated in hospital during 1952, prior to boarding out. During the year, 67 children
were boarded-out solely for segregation during vaccination, but it has been found that
many of these could not return home after converting to Mantoux positive owing to
adverse home conditions or to the mother becoming unfit to undertake the care of the
child.
Boarding out
of child
contacts
Under a scheme which has been in operation for over 25 years the Council arranges
for the boarding-out of children exposed to infection by tuberculosis in their own homes
or whose parent or parents are receiving residential treatment for tuberculosis. The
Invalid Children's Aid Association, as the Council's agents, arrange for the placing of
the children with suitable foster parents, or in private nurseries or voluntary homes.
All remain under surveillance by the chest physicians of the clinics covering the areas
of the foster homes and regular reports are received on their progress. Since the war,
overcrowding and the housing shortage, the long hospital waiting lists and the steady
increase of domiciliary treatment of tuberculosis have led to heavier demands on this
service. Concurrently with the greater competition for foster homes following the
passing of the Children Act, it has become increasingly difficult to find and retain
sufficient suitable foster homes. The need for segregation of children during B.C.G.
vaccination has also led to a widening of the boarding-out arrangements. The average
number of children boarded-out at any one time in 1952, under these arrangements,
was 460 (including 18 children boarded-out solely for segregation during B.C.G.
vaccination) compared with between 130 and 140 before 1939, 180 in 1946, 230 in 1947,
257 in 1948, 326 in 1949, 405 in 1950, and 448 in 1951. The total number of children
boarded-out during the year was 991 (949 in 1951), of whom 434 were children whose
stay extended from 1951. The number of children, included in these figures, who were
segregated for the purpose of B.C.G. vaccination was 82 of whom 15 remained boardedout
from 1951. Arrangements are made to ensure that B.C.G. is given to negative
reactors.
At the end of the year 464 children remained boarded out. The co-operation of
medical officers of health and chest physicians outside London has been excellent in the
boarding-out scheme.