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159
widened to meet the occasional need to segregate children from infectious homes during
B.C.G. vaccination.
The average number of children boarded-out at any one time rose from 257 in 1948
to a peak of 500 (including 14 for B.C.G. segregation) in 1953 since when it has fallen
annually to a figure of 120 (including 4 for B.C.G. segregation) in 1958.
Strenuous efforts are made to find some alternative form of care for these child
contacts, e.g., use of a Council day nursery, child minder or home help service, before
resorting to boarding away from home.
B.C.G. vaccination—The most important development in the Council's services in the
preventive field was a B.C.G. vaccination scheme for children of consenting parents
initiated:
(a) in September, 1950, for susceptible (tuberculin negative) contacts of known
tuberculous patients ; vaccinations are carried out by the chest physicians and
31,155 contacts had been vaccinated by the end of 1958,
(b) in 1953 for diabetic children in the Council's schools. 68 children had been
given B.C.G. vaccination by the end of 1958, and
(c) in June, 1954, for tuberculin negative 13-year-old children attending London
schools; these vaccinations are carried out in the schools by the Council's own
medical officers; 91,746 children had been vaccinated by the end of 1958.
The 14 per cent. of children tuberculin tested and found to be reactors have been
mass X-rayed and among these 1.2 per cent. have revealed active lung lesions meriting
treatment or close surveillance. In schools showing an abnormally high tuberculin reactor
rate among the children special X-ray examination of adult staff members has been
pressed.
Mass X-ray—The mass radiography units provide facilities for the examination on entry
and periodic examination of the Council's staff working with children, and of staff and
senior pupils at its occupation centres for mentally handicapped persons.
Special epidemiological investigations are undertaken on contacts at schools,
nurseries, welfare department homes and other establishments of the Council involving
children and adults whenever a case of tuberculosis is ascertained in an adult working
there.
Home care—In addition to assisting the chest physicians with clinic work the Council's
tuberculosis visitors see patients in their homes to advise on diet, hygiene, etc., to
ascertain home conditions and needs and to persuade contacts to attend the clinic. The
total number of visits in 1958 was 78,953. Home nurses are provided under the
domiciliary nursing service to give patients nursing attention under the direction of the
family doctor or chest physician, and nursing equipment, e.g., back rests, bedpans etc.,
is made available on loan where necessary. 368 patients were receiving attention by
home nurses at the end of 1958. Patients unable to make their own way to the
local chest clinic for consultation or treatment are conveyed by ambulance or sittingcase
car provided through the Council's ambulance service.
Home helps are employed in the homes of bed-fast patients and to care for children
of mothers undergoing treatment. 467 patients were receiving this service at the end of
1958. Extra nourishment (milk, butter, eggs) is provided tor necessitous patients on
the recommendation of chest physicians and patients are also helped to obtain extra
nourishment by the voluntary care committees. The total number of patients receiving
extra nourishment at the end of 1958 was 1,875.
Hostels—Another important development has been the establishment of hostels for
homeless infective tuberculous men who have completed hospital treatment and who,
if a hostel were not available, would live in lodging houses where they might be an
infective risk to other residents. Details of these hostels, the first of which was opened
in 1951, are given on page 51.