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that the degree of protection is not the same in young
children. The American figures also suggest that ten years
is the limit of the protection level that is given by
B.C.G. after which it may start to wane.
What is proposed at present is not that B.C.G. be
given to prevent Tuberculosis throughout life but should
only be given to the thirteen year olds to reduce the
amount of Tuberculosis in adolescents.
It might be suggested that half a loaf is better than
no bread but this would surely be an argument for encouraging
certain districts to remain free of these complicat
ing blankets of B.C.G. until some of these controversial
factors have been sorted out. No doubt these will take
many years to complete satisfactorily, by which time it
is to be hoped that Tuberculosis will have continued its
present trend and will have practically disappeared. If
we are then left with no Tuberculosis but a large machine
manufacturing B.C.G. blankets to control a non-existent
fire where will be our gain?
The great value that has been obtained from Diphtheria
immunisation has undoubtedly been built up on the careful
work of clinics and the avoidance of reactions among the
children. In the widespread use of B.C.G. we shall undoubtedly
give rise to a number of local reactions, some
persisting over a matter of weeks, or even months, which
might easily prejudice many parents against inoculations
of all kinds. Those of us who have had many years in
Public Health know how carefully one must balance the
value of injections against public resentment of reactions
of any kind. For this fact alone I would need much convincing
that the value of B.C.G. in a community such as
Ealing, where adolescent Tuberculosis is becoming almost
a rarity, would outweigh the mass resistance which we are
likely to get to immunisation as a whole.
In Scandinavia it is now thought that mass vaccination
of young children is unnecessary because the risk of
infection is so low and because of the occasional case of
progressive disease due to the vaccination. The abandonment
of B.C.G. vaccination has therefore been urged.
In my view the rate of Tuberculosis among younger age
groups makes tuberculin testing necessary only for the
detection of those who are positive as a result of natural
infection who may then require periodical X-ray examinations
and possibly some medical treatment. It should not