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Occasionally home isolation is possible, especially with babies
in arms; then sometimes the infectious contact is a relation in
another house and contact can be avoided for some time. If there
is an active case of tuberculosis in the family, it means waiting for
the patient to be removed to hospital or for admission to Ardmore
Hostel.
Apart from actual vaccination, the preliminary testing
sometimes gives valuable information. For instance, a child of two
years, whose grandmother was a quiescent case, was found to be
tuberculin sensitive. Further investigation showed that the grandmother's
condition had deteriorated, that she was actually infectious
and required further treatment. The two-year-old child herself had
to be admitted to hospital, but of course was not vaccinated.
Another toddler was admitted to hospital for treatment of an active
primary infection disclosed by tuberculin testing. In another
family, liable to be exposed to future infection, two young children
were found to be tuberculin positive. On investigating the reason,
it was found that there was in the house a lodger suffering from
active tuberculosis. But as I am allowed to vaccinate only known
contacts, we cannot expect to discover many new cases in this way.
Tuberculin tests are often done as an aid to diagnosis in
children attending our ordinary clinics, and during the last few
months of the year several children discovered in this way have been
admitted to hospital for treatment of a primary infection which
was making unsatisfactory progress.
In my opinion there are great advantages in having this work
done at our Infant Welfare and School Clinics. The children are
quite accustomed to come there, where they feel quite at home,
and the Health Visitor and the Doctor are generally known to them
already. On the other hand, at the Chest Clinic there is only one
session a week at which children can attend, and this would make it
very difficult to read tuberculin tests there. If, however, appointments
were to be given for children to attend the adult sessions at
the Chest Clinic, they would be exposed to a risk of infection there;
but, on the other hand, primary tuberculosis in children is not
infectious to others. Again, the necessary follow-up of cases is
much easier to arrange at our own welfare clinics.
Preliminary tuberculin testing is done at all ordinary sessions
at Dawlish Road Clinic, and no special session is set aside for that
purpose. The actual B.C.G. vaccination must be done on one