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with the original case and for two years after this had ceased. The objection to this system
was mainly psychological ; either the contact attended regularly and worried about the
possibility of contracting tuberculous disease, or failed to attend after the first time owing
to carelessness or fear that something would be discovered. In addition, there is a considerable
change of population in and out of the City, and contacts who left the City were
completely unprotected. Probably, owing to the fact that they had been examined and
told originally that there was no evidence of tuberculosis, they were likely to be more negligent
about symptoms than they normally would be.
The number of people who subsequently develop pulmonary tuberculosis as a result
of contact during adult life, provided they show no evidence of heavy tuberculous infection
when they are X-rayed, is very small, and it seems possible that a considerable amount of
psychological damage is being done by the present system.
The new system is to examine each contact case thoroughly at the time when the
original case is discovered. If no evidence of tuberculous disease or heavy tuberculous
infection is discovered, they are informed of this and given a pamphlet telling them that
there is no need to worry unless they develop any of the common symptoms which occur
as a result of the onset of tuberculosis, and advising them of the course to take if symptoms
do develop. The pamphlet which is given to them is shown in Appendix F.
The method of dealing with non-adult contacts has not been changed, as most of the
considerations noted above do not apply. Of course, this alteration of method does not
mean that any abatement has been allowed in the hygienic measures which are applied to
infectious cases.
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