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" The procedure will be to carry out an initial tuberculin test to find out
which children are already ' positive ' to tuberculin and who do not, therefore
need to be done, since only those who are ' negative ' will be given B.C.G.
vaccine. This may be done at either school or clinic.
" If the B.C.G. ' takes ' a small ' pimple ' will begin in two to three weeks
and this will slowly increase in size for another two to three weeks and may
develop into a small shallow sore for which no dressing would be required and
which should heal in a few weeks leaving only a small scar. Any result more
severe should be reported to the family doctor or to me.
" A further tuberculin test will be carried out not earlier than six weeks
after the B.C.G. is given. If the latter has been effective then the previous
' negative ' result will be ' converted ' into a ' positive ' and some protection
against tuberculosis will have been given.
" If a child who is to be given B.C.G. vaccine is living in close contact with
an infectious case of tuberculosis, then if ' negative ' to the test he/she should
as far as possible not come into contact with the patient for six weeks before the
B.C.G. is given."
After the completion of the necessary " preliminaries ", the scheme for
the B.C.G. vaccination of school leavers was able to be commenced in Leyton
in August, when two school Medical Officers began to carry out the
vaccinations.

The figures show clearly the unexpectedly poor response to the offer of
vaccination and the unexpectedly low percentage of " leaver " pupils found
to be Mantoux positive before vaccination.
I give below Dr. Emslie's observations on the progress of the scheme :—
" Response to the offer of vaccination has not been very satisfactory,
although perhaps one could not expect a very good response to the first invitation.
Some parents may have doubts or fears which could be removed, and it might be
considered whether personal explanation to parents at a meeting would produce a
better response. As vaccination is done before the routine medical examination
of school leavers, there is no opportunity of discussing the matter with the parents
at that examination, and in any case parents do not attend well at school leavers'
examinations.
" The percentage of Leyton children Mantoux positive without vaccination,
which is 13 per cent., is much lower than the figure quoted in the National
Tuberculin Survey by the Medical Research Council in 1949 and 1950, which
was 35 per cent. The figures are not comparable for the following reasons :—
" 1. The age of Leyton children was slightly less, which might make a
slight difference.
" 2. The National Survey figures include cases positive to a Flour Paper
Jelly test only, without a Mantoux test. Personal experience and reports from
other sources have convinced me that a very high percentage of positive Flour
Paper Jelly tests are false positives, even with standard technique. Caplin and
others recorded (Brit. Med. J., 16th October) that two ' experts ' Jelly tested
361 children who were Mantoux negative (1 in 1,000), and one expert found
34 per cent, and the other 9 per cent, to be Jelly positive. There have been a
number of reports with similar findings.