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TUBERCULOSIS
Notification rates of pulmonary tuberculosis were slightly lower than in 1962 and the
death rates followed the same general trend. The diagram on page 24 shows the trend of
notifications, deaths and numbers on the registers of chest clinics over the last decade.
Deaths from non-pulmonary tuberculosis are now so few that considerable random
fluctuations occur in the rates from year to year and therefore are not shown in the diagram.
The number of cases on the registers is now 32,301. The 265 deaths from tuberculosis (all
forms, both sexes) include 156 deaths from pulmonary disease in men aged 45 and over.
Services provided—The services provided by the Council as local health authority for
the care and after-care of tuberculous patients and the prevention of tuberculosis are
summarised in table T.9.
Care committees—The voluntary tuberculosis care committees associated with most of
the 29 chest clinics in London continued their valuable work of assisting patients and their
families financially or in other ways where help was not available from official sources. The
Council's chest clinic welfare officers act as secretaries to these committees.
B.C.G. vaccination—The numbers of children vaccinated during the year, under the
Council's schemes for the B.C.G. vaccination of susceptible (tuberculin negative) child
contacts of known tuberculous patients, diabetic children, thirteen-year-old schoolchildren,
students at further education establishments and mentally subnormal persons at training
centres, are shown in table T. 11.
Preventive measures—In addition to the B.C.G. vaccination schemes, other preventive
measures include the chest X-ray of all newly appointed staff who are likely to work in
close and frequent contact with children, staff at the Council's training centres for mentally
subnormal persons and of tuberculin reactors discovered among thirteen-year-old schoolchildren,
students and others tested with a view to B.C.G. vaccination.
Epidemiological investigations are made among the contacts of cases of tuberculosis
notified in children, staff or residents in the Council's establishments. Similar investigations
are carried out at secondary schools where the reactor rates disclosed by tuberculin surveys
are significantly higher than the average for secondary schools in the area (table T.8).
The following table summarises the findings of a number of groups of home contacts—
mostly adults—examined by X-rays living with children who had been ascertained as
tuberculin reactors at schools and child welfare clinics.
It will be seen that this form of investigation discloses little in the way of new, hitherto
unknown, cases of active pulmonary tuberculosis needing treatment or close supervision.
Not surprisingly, a higher proportion of such cases is found among household contacts of
'severe' (20 mm. or more Mantoux reaction) reactors than in those of milder reactors.
It is very doubtful whether the disturbance and anxiety attending such investigations
warrants conducting them routinely on household contacts of mild tuberculin reactors.
Year and place of survey Age group T 'bin tested Technique Number tested Reactors discovered New active Tb on X-ray in reactors Home contacts X-rayed New Tb discovered in home contacts
County 1954-56 13yrs. Mantoux 10TU 38,287 999* 12 1,097 3
Hackney 1955-57 5-7 yrs. Jelly & Mantoux 750 6 0 14 0
Lambeth 1962 13 yrs. Mantoux 10TU 3,683 255 0 325 0
*AII 'severe' (-20 mm.+) reactors.
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