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Preventive measures
Tuberculosis is a widespread infection which progresses to disease only in those susceptible
individuals whose physical, nutritional or emotional resistance is inadequate to
counteract the destructive activity of the invading germs.
Any measures therefore which tend to foster and improve well-being, nutrition
and contentment are calculated to increase resistance to tuberculosis. All those general
health measures such as ante-natal supervision, child welfare services, school health
services, school meals and milk, health education, better housing and food supplies,
contribute to improvement in the tuberculosis position. The high standard of diagnostic
facilities available from family doctors and at the general and special hospitals, with
which London is well endowed, are also valuable preventive aids.
Of the more specific preventive measures which are directed against the disease,
special mention may be made of the arrangements in London for seeking out, examining
and keeping under medical supervision the contacts of known cases. In 1954,13,219 contacts
of the 4,534 newly-notified cases were examined at chest clinics and among them
were found 338 cases of tuberculosis. The Council provides special services for susceptible
children in contact with known cases. ' Boarding out' away from home is
arranged either to enable a mother to undertake treatment, to remove a child from
special infective hazard in a very crowded and unsatisfactory home, or to protect a
child from the risk of infection during the process of B.C.G. vaccination. In 1954
arrangements were made for 450 children to be boarded away from home. Every effort
is made to find some alternative form of care for these child contacts so as to avoid
separating children from their parents, brothers and sisters and homes before resorting
to ' boarding out'. While away with a foster-mother or at a residential nursery, arrangements
are made for child contacts to be periodically examined by the Chest Physician
of the nearest clinic and he is asked to report periodically on the child's condition and
progress. In all aspects of this work the Invalid Children's Aid Association, acting as
the Council's agent, provides invaluable assistance.
Contacts
Mention should be made of the special procedure which was initiated in London a
few years ago, of making thorough investigations of the school, nursery, institutional
or workplace contacts of cases of tuberculosis notified among the staff or residents in
the Council's departments and institutions. A summary of the findings of such 'incidents'
is given on Table T9 (page 36).
One of the most effective contributions to the prevention of tuberculosis in recent
years has been the progressive availability and use of the new specific antibiotic and
chemotherapeutic drugs employed alone or in association with bold and drastic surgery.
These measures, by reducing or neutralising the infective potential of patients, have made
it much safer for children and adolescents to live or work in close contact with most of
them. Ten years ago nearly a third of all lung cases attending a chest clinic were ' sputum
positive ' ; now the proportion is reduced to less than a tenth of the total.
The mass miniature X-ray units of the tour Metropolitan Regional Hospital Boards
steadily, albeit incompletely, combing the adult population for undisclosed cases of
chest disease, are a preventive resource of undoubted value. The findings reported by
these units are set out in Table T10 (page 37).
Mass X-ray
The Council continued during the year to arrange for a chest X-ray examination
of all those newly-appointed members of its staff who were thought likely to come
into close or frequent contact with children during the course of their work.
B.C.G. vaccination has been provided under the Council s auspices since 1950 at
chest clinics in London for those susceptible (tuberculin negative) contacts of known
cases, when parental consent is given. Between September, 1950 and December, 1954,
a total of 13,156 such children (including boarded-out contacts) had been vaccinated
under the Council's arrangements. Since 1953, after special approval by the Minister of
Health, the Council has provided facilities for B.C.G. vaccination of those particularly
susceptible diabetic children in its care. In June, 1954, a further advance was made in
B.C.G.
vaccination
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