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Tuberculin skin testing has again revealed that four out of five school leavers are still free from
infection (table 23).
Children showing a positive tuberculin test (thus revealing previous infection) are all referred for
X-ray examination as a precautionary measure; no active cases were found (see also Co-operation, para. 2).
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. It is satisfactory to
report that only 1 per cent of these children under five had previously been infected. The low figure of 4 per
cent was recorded for school entrants (table 23).
Missed Notifications
There has been a slight reduction in the proportion of persons who die from tuberculosis previously
un-notified (table 25). This provides another indication that the extent of infection in the community is
less, but there is still an undiagnosed pool of infection in the borough as indicated by the fact that one in four
deaths still takes place in unnotified persons (table 25).
Over the last five years, an increasing proportion of deaths among persons known to be tuberculous
occurred more than five 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
Five factories and workplaces where active cases of tuberculosis had been discovered were visited,
and arrangements were made for 38 immediate contacts from four of these places to attend for X-ray
examination: the results were all satisfactory. The mass X-ray unit also visited one of the factories at the
request of the management on the advice of the Medical Officer of Health.
Six hundred and sixty-five employees (75 per cent of the total staff) were examined and all were
found to be satisfactory. The staff at the fifth factory had already been X-rayed, but arrangements were made
for them to be re-examined early in 1957.
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 tuberculosis patients in Willesden was increased in 1954, and is
now adequate for the immediate treatment of cases requiring hospitalisation (see Report of 1955 for details).
Co-operation
Four meetings were held during the year. One ordinary committee meeting was attended by the
Medical Officer of Health, the Chest Physician, Assistant Medical Officer, Welfare Officer, the Disablement
Resettlement Officer, the Superintendent of Health Visitors, Midwives and Home Nurses, the Home Help
Organiser and the Chief Public Health Inspector. Among the problems discussed were factory contacts,
the spread of infection in overcrowded lodging houses, and compulsory removal of active cases to hospital.
At two special meetings attended by the Medical Officer of Health, the Chest Physician and Assistant
Medical Officer the scheme for the follow-up of tuberculin positive school leavers was revised; because
school leavers with strongly positive reactions have shown a higher incidence in later years, arrangements were
made for those with third degree Heaf reactions to be followed up by regular X-rays at the mass X-ray unit,
and for those with fourth degree reactions to attend the Chest Clinic for regular X-rays, follow-up and
investigation of contacts.
A special meeting was arranged with the Physician-in-charge of Mass X-ray Unit 5A to discuss
improvements in the scheme for the examination of factory contacts. Several changes were made, the main
one being that contacts are now invited to attend for X-ray every six months for two years. Previously
only one attendance was made.
A special meeting was also arranged with the Physician-in-charge of Mass X-ray Unit 5B and
arrangements are now made for talks on mass X-ray to be given by the Medical Officer of Health in factories
just prior to the Unit operating there.