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17
Council in this country which showed that the use of B.C.G.
did lower the incidence of the disease among adolescents
by about 50% has posed a dilemma as to the use of B.C.G.
for all Authorities concerned in this matter.
What is the position in Ealing? We are well aware of
the rapid fall in our tuberculosis mortality and the likelihood
of its disappearance in a few years. We know that
the number of tuberculosis deaths among adolescents, that
is the 15 24 year age group, during the last three years
was only one (This was a twenty-three year old girl who
died in 1955 having been ill over a period of about ten
years and having had severe surgical operations on her
lungs and coming from a family well known to be subject
to tuberculosis). There has been no other case of a death
in this 15-24 year age group for three years. Any steps
therefore, which are taken in Ealing to reduce infection
in this group can be only of very small significance since
the total notifications in this group for the same period
is only nine. It might be argued that some of these cases
might not have occurred had B.C.G. been given but against
this must be weighed the fact that many of these cases
will undoubtedly recover and in fact had our intensive
search been less meticulous it is more than probable that
few of these cases would have been discovered and placed
under observation.
The giving of a live Tubercle bacillus, however aviru
lent it may be, must carry some chance of reaction, more
severe in some than in other individuals. This must be
weighed against the reactions that would be obtained by
the use of Tuberculin Testing on a large scale among all
adolescents. We of course would lose the opportunity which
so far we have preserved of having a controlled group by
which to measure the decline of Tuberculosis in our district
as compared with that in other areas where B.C.G
has been used. This matter is one for careful consideration
and should, in my view, be left to the discretion of the
Local Sanitary Authority, who are the Authority concerned
with the prevention of the spread of infectious disease.
Unfortunately, the National Health Service Act places the
prevention of disease in this context, namely that of
vaccination and immunisation in the hands of the Local
Health Authority, which, as far as Ealing is concerned,
is the Middlesex County Council. It has now been decided
by the Middlesex County Council that B.C.G. vaccination
shall be made available in all Boroughs of Middlesex and