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Mantoux tests was somewhat smaller than in the previous year, and so, although the proportion of acceptances
was higher, the numbers vaccinated were actually smaller. Altogether, 391 (about 1 in 5) of the
school-leavers were vaccinated, and probably less than 50 who required vaccination did not have it (Table
6). It is hoped that in subsequent years even more parents will give consent and thus help to protect their
children.
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 (Table 6).
Detection of Cases
Missed Notifications
The number of people who died unnotified is an indication that there must be many undetected
infectious cases in the community. In the last five years 2 out of 10 who died were unnotified, 2 died within
a year of notification, and another 3 died within five years (Table 7). Some of these must have been infectious
and remained undetected, so that adequate precautions could not be taken to prevent the spread of
infection. A study of all those who died unnotified reveals that further investigation of elderly patients
suffering from bronchitis and emphysema is required. A letter was sent to the secretary of the medical
committees of all hospitals in the area stressing the need for notifying all cases.
Chest Clinic
The centre for detecting cases and tracing and examining contacts is the chest clinic. This important
work has been helped by the extension to the Pound Lane Clinic completed in March, 1953, providing
a new X-ray department with an adjacent dark room, a miniature camera unit (Watson 5" x 4") added to
the four valve set, and a separate chest screening stand 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.
Mass Miniature Radiography
The static M.M.R. unit established at the Central Middlesex Hospital in August, 1952, has also
played an important part in detecting cases. Special emphasis is placed on the following groups : people
with suspected diseases of' the lungs, particularly those under the care of their family doctor; contacts of
infectious cases of tuberculosis; health workers, including 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 out-patients; and expectant mothers. The highest proportion of cases are found in those
who are referred from their own doctor and the next highest in in-patients. In addition, other abnormalities
such as cancer of the lung, bronchiectasis, and pleural effusion are also detected and can receive earlier
treatment (Table 8).
An evening session was arranged for the last Monday in each month from 6.0 to 8.30 p.m.,
commencing in May, and considerable publicity was given to this. Notices appeared in the Willesden Citizen
and Willesden Chronicle, letters were sent to ten old people's clubs offering a talk on tuberculosis, circular
letters were sent to all medical practitioners and to the secretary of the medical committee of all hospitals
in the area. Wherever possible, old people are encouraged to attend day sessions, but if parties could be
arranged, transport could probably be provided. All the special groups, including school-leavers, who cannot
attend day sessions, may come to the evening sessions.
Factories and Workshops
A study of mortality in different occupations reveals the important role played by working conditions.
Recent surveys have shown that overcrowding in large workshops is an important factor in the
spread of the disease, particularly if there are undetected cases working there.
It is therefore important to examine factory contacts of all infectious cases discovered, and try
and determine where they contracted the disease and who else may have been infected. At the same time
other abnormalities such as cancer of the lung and silicosis can be detected.
Arrangements were made to examine contacts of infectious cases in 12 factories, workshops and
offices and cases were found among the contacts (Table 9). The case found to be suffering from tuberculosis
was admitted to Central Middlesex Hospital, and he has now been discharged but still attends for
refills to his A.P.; he is unfit for work but is making good progress.
When visiting factories for tracing contacts the medical officer of health encourages managers to
employ non-infectious ex-tuberculosis patients on both his and the chest physician's recommendation.
Whenever there are vacancies in industry suitable for tuberculous persons and the disablement
resettlement officer requires a report, the sanitary inspector visits and reports whether working conditions
are satisfactory. It was recommended that no recovered tuberculosis cases be referred to one particular
factory during the year.
Several cases were referred for training at the Government training centre at Perivale.
Hospital Accommodation
If more cases are to be discovered, it is also essential 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 10 female and 10 male beds in Neasden Hospital. In addition, a number