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of the shortage of material, to extend B.C.G. innoculations
beyond the thirteen year old group there is a presumption
that B.C.G. would be extended to the infant groups when
more material becomes available. It is well realised from
the Medical Research Council's investigation that 40% of
the children are found to be positive reactors and they
form a large group in which Tuberculosis cannot be prevented
in any case by prophylactic vaccination. It would there
fore be necessary if B.C.G. was to be used to its fullest
value to offer at a much earlier age, probably before the
child had had a chance to acquire Tuberculosis infection
naturally, the same vaccination as has been offered under
the Ministry of Health scheme.
The use of B.C.G, on a mass scale among the whole
population, rather than as a weapon in the hands of the
Chest Physician to prevent development of infection among
selected individuals at high risk, is, in my personal view,
an unjustified procedure at this stage in the epidemiological
history of Tuberculosis (It is known that in
recent years the examination of contacts of known cases
has produced 8% of new notifications, These people are of
course a greatly increased comparative risk and should be
treated as a selected group). Had Ealing remained its own
arbitrator in this connection I believe that they would
have given long and careful consideration to the desira
bility of introducing this grape shot' method of attack
in an area such as this, rather than relying upon the
efficient judgment of their Chest Physician whose know
ledge of this disease in all its manifestations in local
conditions is unsurpassed.
It is important that the public should be aware of
the differences in B.C.G. vaccination and Diphtheria
immunisation. In the case of B.C.G. of course there must
be preliminary Tuberculin Tests and subsequent tests to
be made to ensure that the B.C.G. which is a live germ
has been effective.
With regard to Diphtheria immunisation, the material
which is purely chemical and is in no sense a live organ
ism, is given in two injections and no further testing is
necessary.
We do not know the length of protection which can be
afforded by B.C.G. vaccination, nor do we know if the
degree of protection is the same in young children as in
adolescents. In fact, there are American figures to suggest