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the active immunisation of children against tuberculosis by instituting routine B.C.G.
vaccination for all those tuberculin negative 13-year-old children whose parents had
given consent. A new laboratory was established for this work in the County Hall and
special equipment designed to meet the needs of the large numbers (approximately
36,000) of children of this age in London who each year will be offered the protection
against tuberculous infection which B.C.G. vaccine affords. The special arrangements
made for this new service have been carefully planned and, together with the enthusiastic
and practical co-operation of parents and head teachers, make this organised preventive
measure the largest of its kind in the country. The scheme was introduced gradually in
London from June, 1954, and by the end of the year 4,785 children aged 13 years had
been tuberculin tested at their schools by a newly-appointed specialist full-time medical
officer and the 4,037 negative reactors among them, vaccinated with the specially tested
Danish vaccine provided by the Ministry of Health. It is expected that in a full year's
working, with two full-time specialist teams visiting all schools, it will be possible for
about 27,000 adolescents (i.e., 75 per cent. of all school leavers whose parents accept
the proffered service each year) to be tested and those found susceptible to be vaccinated
with the best available B.C.G. vaccine.
Up to the present time, it has been found that 75 per cent. of the London parents
offered vaccination for their 13-year-old children accepted and that only 15 per cent.
of these children not in contact with a known case of tuberculosis and who were tuberculin
tested were found to be 'positive reactors'—that is, already infected by the
tuberculosis germ (though not necessarily actively diseased) and therefore outside the
category to which B.C.G. vaccination is applicable. From the findings in the available
groups tested, it would appear that in present circumstances some 80 per cent. of 13-yearold
London children have not been 'sensitized' by Bacterium Tuberculosis and would
safely benefit by that degree of immunity which B.C.G. vaccine affords.
As residual parental hesitation and doubt become dispelled by education and example,
it is hoped that all susceptible children leaving school will have developed, through
B.C.G. vaccination, adequate protection against the markedly increased risks of tuberculous
infection which experience shows beset those with such intensity and persistence
between the ages of 16 and 25 years.
' Care and
after-care'
Services provided for the tuberculous patient (see Table T1l, page 38).
The Council provides or arranges certain 'Care and After-Care' services for tuberculous
Londoners. These are mainly in the nature of nursing, domestic, welfare and rehabilitation
provisions designed to assist medical treatment or to augment working capacity
and opportunity for the partially disabled or the quiescent case.
For the convalescent tuberculous child not yet vigorous enough to return to normal
school life, facilities are provided for a stay of some months at day or boarding
open-air schools where educational activities are continued at a gentle pace in good
surroundings with special emphasis on rest periods, medical supervision and nutritious
dietary. For the convalescent adult, ' recuperative holidays 'are arranged in country or
seaside surroundings for up to four weeks at homes specially approved as suitable for the
tuberculous.
For the patient still under treatment at home or at the chest clinic, the Council
provides health visitors specially trained in tuberculosis to help the doctor at the clinic
and to visit patients in their homes to advise them on details of hygiene, to fortify,
instruct and encourage them and to ascertain the home conditions and needs.
The Council also provides and maintains at each clinic one or more care organisers
who are experienced social workers mostly having a local voluntary Tuberculosis Care
Committee from which they can obtain financial and other help for needy patients.
Their duties include ascertaining and providing for the patients' material needs. With
the health visitors at the clinic they help patients in their anxieties; guide them to
agencies (e.g., the National Assistance Board, the Ministry of Labour, the Housing
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