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risk to others, particularly susceptible adolescents. The improvement in hospital facilities has resulted in
the early removal of infective cases from the community. Finally, the improvement in health education
and a knowledge of hygiene has permitted the treatment of cases in the home without placing members of
the family at risk. Health visitors, home nurses, and home helps have played a very important part in this,
and it is probably true to say that where suitable precautions are taken, contacts in homes where a known
case of tuberculosis is treated are safer than some members of the public who repeatedly come in contact
with unknown cases.
B.C.G. Vaccination
Another way of increasing resistance is by B.C.G. vaccination. In this country where the
incidence of tuberculosis is relatively low, B.C.G. vaccination must be selective.
On January 1st, 1953, arrangements were made to commence vaccinating susceptible tuberculinnegative
school-leavers to protect them before they enter the vulnerable age groups when they undergo the
stresses and strains of adolescence, the more arduous work and travelling in commerce or industry, and the
greater risks of contact with infectious cases.
Those who are tuberculin-negative attend for a Mantoux test and if negative they are vaccinated
with B.C.G. In addition, children have been tuberculin-tested at infant welfare clinics and at the periodic
medical inspections at school. Those who have been positive have had an X-ray of the chest at the chest
clinic, and their social and family history investigated to determine the source and extent of the infection.
Mass Miniature Radiography
Arrangements have been made for the examination of the following groups at the static M.M.R.
unit established at the Central Middlesex Hospital in August, 1952 :—people with suspected diseases of the
lungs, particularly those under the care of their family doctor; contacts of infectious cases of tuberculosis;
health workers, for instance nurses and medical students; people who come in frequent contact with
children, namely teachers, domestic staff in schools and day nurseries; all hospital admissions and outpatients;
and expectant mothers. About 25 in every 1,000 persons examined by the M.M.R. unit during its
first six months were found to have active tuberculosis.
Out of 14,236 out-patients examined, 57 were found to be cases of active or presumed active
tuberculosis; nine in-patients out of a total of 2,465 were found to be suffering from the disease.
Doctors referred 4,719 patients for X-ray and 4,279 came of their own accord. Of the former, 91
were found to be suffering from tuberculosis, and of the latter, 14.
Staff at the hospital and applicants for staff appointments were X-rayed, and of these seven out
of 1,167 were found to have active tuberculosis. 536 patients referred by area medical officers were examined,
of whom four were found to have tuberculosis.
The rate of active cases per thousand X-ravs was 6-3, or 182 cases out of 27,420.
Factories
Arrangements were made to trace contacts of infective cases in 7 factories; and 365 employees
attended for X-ray examinations. 337 were found satisfactory and in 28 some abnormality was detected.
Of these 28, 19 were not suffering from tuberculosis, 6 had arrested tuberculosis, and no further action
was taken, and further investigation was necessary in 3 as follows:—
Case A. Home address outside district and details were sent to the Paddington Chest Clinic.
Case B. To be re-examined in August, 1954.
Case C. Treated at home, then admitted to Neasden Hospital on 23rd July, 1953, and discharged on
7th November, 1953. Now attending for refills, unfit for work, but making good progress.
Chest Clinic
The centre for detecting cases is the chest clinic and it is essential that facilities should be adequate
for its increasing activities. Work was started on extensions to the clinic in June, 1952 and completed
in March, 1953. During this period, the Council provided accommodation at a temporary clinic at 159,
Willesden Lane, and office staff were transferred to the clinic at the Neasden Hospital, which had previously
been used as a scabies and lice treatment centre. The Pound Lane clinic now has a new X-ray
department with an adjacent dark room, and a miniature camera unit (Watson 5" x 4") added to the
existing four valve set; a separate chest-screening stand has been made available in the main consulting
room. Accommodation for patients in the waiting and dressing room cubicles has been increased and
additional accommodation has also been provided for the medical and nursing staff.
Hospital Accommodation
If more cases are to be discovered, it is also essentia! to provide hospital beds for them as
required. Hospital accommodation has therefore been increased; there are 30 female and 28 male beds
in the Central Middlesex Hospital and another 20 male beds in Neasden Hospital. In addition, a number
of beds (approximately 50) are available in the chest hospitals of the North-West Metropolitan Regional
Hospital Board. As a result of the improvement in the bed situation and domiciliary treatment, the waiting
list has been reduced to a few days only.