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" It is apparent that the death rate from tuberculosis among the contacts
is eight times the control rate, while the total tubercle incidence rate is over
sixteen times the control rate. It should be borne in mind that this control
rate is probably much too high."
This conclusion, which is of general applicability, shows the great
importance of the examination of contacts.
The report concludes with the following words:—" This report has
endeavoured to make plain the following truth.
" It is only by co-ordinated progress along various paths and by surveying
the complex problem as a whole that tuberculosis is likely to be combated
successfully."
A further report of interest to all those concerned with anti-tuberculosis
work, entitled " The Value of Tuberculin Tests in Man," by Dr. P. D'Arcy
Hart, was issued by the Medical Research Council (No. 164) during the year
here under consideration. The matters dealt with in this report are for the
most part of a technical character, but the following conclusions relating to
tuberculosis in childhood are of general interest: —
"It is suggested that steps should be taken to improve the present
methods of preventing tuberculosis in children of tuberculous parents. The
formation of further settlements of the Papworth type might possibly be
considered, together with a voluntary system for the separation of infants
from their parents before infection, as shown by a positive tuberculin reaction,
has taken place. These infants should be placed in healthy families
for a period of several years. If infection has already occurred, the advantage
of separation is less certain.
Home conditions are an important factor in the fate of children living
in tuberculous families, and their amelioration may compensate to a certain
extent for the presence of an infective adult. Whether this result is due
more to prevention or limitation of infection, than to an effect on its subsequent
course in the body, is not yet clear.
" Tuberculous infection in London children of the poorer classes appears
at the present time to be acquired for the most part in later childhood and
adolescence, i.e., during a period when the principal activities of the individual
are away from the home. Almost all are sensitive to tuberculin
when adult life is reached.
" Systematic tuberculin tests on children may throw light on a new
clinical entity—a transient and benign illness accompanying tuberculous first
infection. Owing to the unobstrusive and temporary nature of its symptoms,
it is likely that the tuberculous origin of the illness usually escapes recognition.
The detection of a positive skin reaction in a prevously tuberculin-negative
individual may assist in establishing the tuberculous nature
of the symptoms."