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TUBERCULOSIS
In 1948 the diagnostic and treatment services in respect of tuberculosis became the
responsibility of the newly-constituted regional hospital boards. In consequence, the
tuberculosis dispensaries in London, most of which had been provided by the metropolitan
borough councils, were transferred to the metropolitan regional hospital boards. The
provision of preventive and 'care and after-care' services at these dispensaries (later
renamed 'chest clinics'), previously included in the Council's comprehensive scheme for
the diagnosis and treatment of tuberculosis, became the direct responsibility of the Council.
An account of the principal developments in these services follows.
Preventive services
Tuberculosis contacts—The Council continued to operate a scheme, already in existence
for over 20 years, whereby children are boarded-out to protect them from infection by
tuberculosis in their own homes or to enable their parents to undergo treatment in hospital.
In 1950 the scheme was widened to meet the occasional need to segregate children from
infectious homes during B.C.G. vaccination.
Placing the children with suitable foster parents or in private nurseries was undertaken
by the Invalid Children's Aid Association, acting as the Council's agent, until 1961 when
this work was undertaken directly by the Council.
Before boarding away from home is resorted to, the possibility of some alternative
form of care, e.g. day nursery, child minder or home help service, is considered. A number
of children were thought to have suffered adversely by prolonged removal from home
and it became a point of policy only to board a child away from home when no other
course was practicable.
The number of children placed under the scheme rose from 362 in 1948 to a peak of 600
in 1953, since when it has been steadily reduced to 77 in 1964.
B.C.G. vaccination—An important development in the preventive field since 1950 has
been the initiation of B.C.G. vaccination schemes:
(a) in 1950, for susceptible (tuberculin negative) contacts of known tuberculosis patients;
(b) in 1953, for diabetic children in the Council's special residential school for such
children;
(c) in 1954, for tuberculin negative 13-year-old children attending London schools;
(d) in 1959, for students at establishments for further education within the county—
private, Council and university.
The tuberculin testing surveys, which are a first step in the vaccination programme each
year, in addition to showing who will benefit by B.C.G. vaccination also provide an accurate
reflection of the amount of infective tuberculosis in the adult groups in the school, district
and community from which the tested children come. This gives an epidemiological pointer
to where mass radiography should be particularly directed by indicating foci of infection.
Children who show 'severe' (more than 20 mm.) local reactions to the moderate dose
(10 tuberculin units = 0 0002 mgm.) tuberculin test have been found to manifest twice
as many (1.6 per cent.) active lesions on chest radiography as was found among moderate
(5-20 mm.) reactors. It was therefore made a routine practice to X-ray annually, while
they remained at school, those severe reactors whose first chest X-ray was normal. The
many cases of active disease discovered in this way over the years and put on to treatment
early has formed a valuable by-product of the protective B.C.G. vaccination scheme.
These cases discovered by routine X-ray after a positive tuberculin test form a substantial
proportion of the notified cases in their age group and many might have pursued a benign
course undiscovered.
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