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was seen periodically as long as contact was maintained 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. Further, 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 seemed possible that a considerable amount of
psychological damage was being done by the system in operation.
A new system was adopted in 1937, and this provides for the examination of 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 E.
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.