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15
B.C.G. Vaccination
The work of the Medical Research Council has now shown conclusively that B.C.G. vaccination of
school leavers is a very successful additional measure in the prevention of tuberculosis. The unvaccinated
tuberculin-negative school-leaver is five times more likely to develop tuberculosis than are his vaccinated contemporaries.
The arrangements made in 1953 for vaccinating tuberculin-negative school leavers have been continued.
Protection is afforded to young people who are more susceptible to tuberculosis and are embarking
upon a more arduous industrial or commercial life where they will be more freely exposed to infection.
The higher proportion of negatives to tuberculin skin-testing, necessary as a preliminary to B.C.G.
vaccination, reveals a much larger group of children reaching school-leaving age in 1955 without having previously
been infected with tuberculosis. In fact, the percentage of positives (of those infected), has dropped
by two-thirds (Table 5), and now almost 80% of school-leavers require B.C.G. vaccination.
This change may be accounted for by the reduction in the pool of infection and in the introduction
of a more reliable method of skin testing (multiple puncture) during the year. The advantage of the new
test lies not only in its greater reliability, but in its being more acceptable to the public, with only one attendance
required instead of two. The acceptance rate for B.C.G. has therefore improved since the test was introduced,
and with the larger number of children needing B.C.G. vaccination this year, have resulted in a
much larger number of vaccinations being performed. Altogether 1279 school leavers were vaccinated—about
1 in 2 of the total school-leavers population as compared with 1 in 5 in 1954 (Table 6). Nevertheless, many
children who required vaccination failed to attend. It is sincerely hoped that parents will co-operate more
fully in the future and so help to protect their children.
Children showing a positive tuberculin test (thus revealing previous infection) are all referred for
X-ray examination as a precautionary measure. Only one such child (a school leaver) out of' 425 schoolchildren
referred to the Chest Clinic was found to have pulmonary tuberculosis.
Annual tuberculin testing was continued in the Infant Welfare Clinics as part of the routine yearly
medical examinations of young children under 5 years of age, and it was repeated at their first medical inspection
as school entrants. In such young children a positive tuberculin test has particular significance, because
it may indicate a recent infection and the need for a close follow-up of the child and an investigation of the
family. The child and the family are referred to the Chest Clinic for these examinations.
Missed Notifications
There has been a slight reduction in the proportion of persons who die from tuberculosis previously
un-notified (Table 7). This provides another indication that the extent of infection in the community is less.
Over the last five years, an increasing proportion of deaths among persons known to be tuberculous
occurred more than 5 years after notification, demonstrating once again that modern chemotherapeutic
treatment is effective in prolonging life.
Chest Clinic
The Chest clinic is the main centre for detecting new patients, a very large proportion of whom are
referred for investigation by their family doctors.
Factories and Workshops
Arrangements were made to examine 111 contacts of infectious cases discovered in five factories and
workshops. The reports on 109 were satisfactory but two X-rays were doubtful, resulting in further investigation.
Fortunately only one of these persons proved to have tuberculosis.
It has been shown that overcrowding in large workshops is an important factor in the spread of
tuberculosis when an undetected sufferer is working there. The routine X-raying of all contacts when such
a case is discovered is therefore of the greatest value: furthermore a repeat survey after an interval of some
months may reveal patients not previously detected.
Every effort is made to return non-infectious ex-tuberculous patients to suitable vacancies in
industry.
Several cases were referred during the year for training at the Government Training Centre at
Perivale.
Hospital Accommodation
The hospital accommodation for tuberculous patients in Willesden was increased in 1954, and is now
adequate for the immediate treatment of cases requiring hospitalization.
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 of beds (approximately 50) are available in the
chest hospitals of the North West Metropolitan Regional Hospital Board.
Co-operation
Two meetings were held during the year, when the Chest Physician, Welfare Officer, Superintendent
of Health Visitors, midwives and Home Nurses, Home Help Organiser and Chief Sanitary Inspector were
present.
Questions relating to the follow-up of tuberculin-positive school entrants, factory contacts, regular
routine X-ray of teachers and the spread of infection in overcrowded lodging houses were among the problems
discussed. Further measures to improve the existing schemes and arrangements were suggested.