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who had infected him. In the country as a whole 6,841 cases were
discovered by this means, or 4.6 per cent. The incidence of tuberculosis
in some 16,000 contacts examined at the Edgware Chest Clinic in 1949-52
was six per thousand. One-twelfth of the new cases discovered in the
country as a whole were found amongst the contacts of known cases.
(b) Examination of class or school contacts of pupils recognised to
be suffering from pulmonary tuberculosis. At a number of schools in
this district all the pupils were examined following the discovery that one
pupil was suffering from the disease. As the findings were negative,
recent investigations have been limited to the immediate class contacts.
Although a number of such examinations have been undertaken here no
cases have been discovered by this means. It might be more profitable
for efforts to be concentrated on the examination of the teachers or
other adult members of the staff.
In December, 1953, a pupil at a girls' grammar school was found to
be suffering from pulmonary tuberculosis. Because some cases had
been discovered amongst the pupils at this school when they were mass
X-rayed in 1951 arrangements were made for the immediate contacts of
this pupil to be examined; no other cases were discovered. In January
a pupil of a private school was notified as suffering from pulmonary
tuberculosis. The immediate contacts were examined by the skin test,
positive reactors being referred for X-ray examination. No other cases
were found amongst these contacts. Apart from these cases four pupils
attending primary schools in the district were recognised to be suffering
from pulmonary tuberculosis and one pupil of a secondary modern
school. Four of these cases were known contacts of cases, in most
instances close home contacts. As there was no reason for ascribing
the source of infection to attendance at school and as the patients themselves
were not infective so that there were no risks to others at the school,
no special examination of the pupils at these schools was carried out.
(c) A positive tuberculin reaction indicates previous exposure to
the tubercle bacillus. A positive reaction in a young child might then
be the result of a home infection, so that the routine tuberculin testing
of young children followed up by the examination of the home contacts
of the positive reactors might lead to the detection of unrecognised cases.
Where tuberculisation is high, such enquiries might not be worth
while, and in such circumstances the following-up of the contacts of a
child whose reactions have recently changed might be more fruitful.
The Education Committee agreed to facilities for tuberculin testing
being offered to the pupils at two schools at the time they were being
examined at their first routine school medical inspection. The head
teachers were most helpful and the parents very willingly agreed to the
skin testing being carried out. This testing caused no undue disturbance
to the running of the school and did not necessitate any reduction in the
numbers of children being submitted for examination. Unfortunately,
however, there were only small numbers of pupils at these schools due
for examination on that occasion so that no definite answer was obtains
to the question of whether the routine testing of entrants to schools in
this district would lead to the recognition of hitherto undetected cases.