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98
be tuberculin positive. The need for more services is largely a need for
more static units which are best sited at hospitals. Mobile units should
direct most of their attention to people in whom the prevalence of tuberculosis
is likely to be high or the risk of spread great; e.g., those in poor,
overcrowded areas, older men, teachers and others dealing with children,
food handlers, vagrants and tuberculin positive children." In 1956 in the
country as a whole twenty-one per cent, of new cases were detected by
these means.
Examination of Contacts. Home contacts of those recognised to
be suffering from tuberculosis are encouraged to attend the chest clinic
for examination, not only with a view to detecting in the earlier stages
the disease which the primary case might have passed on to those contacts,
but also to detect the person who might have given the disease to the
first patient recognised. Apart from these arrangements which are part
of the routine procedure at chest clinics, special attention is paid to the
school child in one of two ways:
1. The first is the examination of the contacts of a recognised case
when a school child or a teacher is found to be suffering from pulmonary
tuberculosis. The question is gone into of whether it is advisable for the
class contacts to be examined either with the object of detecting the
disease in those who might have been infected, or to detect some other
person who might have caused the infection in the first case. During the
year one school child and two teachers were notified. It was felt desirable
that investigations should be carried out. In addition, investigations were
carried out of the contacts of two other school children who had been
notified late in 1956. The procedure these days is that those in the class
alone are dealt with, these children being tuberculin tested and the positive
reactors referred to the chest clinic. The following is a summary of the
findings:—
(i) A school child notified in December, 1956: 34 class contacts were
tuberculin tested, of whom eight were positive; two of these were
kept under further observation.
(ii) A school child notified in November, 1956: Of 22 class contacts
examined, four were positive; one was kept under observation.
(iii) A school child who moved from one school to another: 199 pupils
were tested; 27 reacted positively, six were kept under observation.
(iv) A teacher: A class of 34 were tuberculin tested, all being found to
be negative.
(v) A teacher: A class of 31 were tuberculin tested. Of the three positive
reactors, two had previously had B.C.G.; the other had probably
been infected at home.
2. The other is the tuberculin-testing of school entrants. The
arrangements by which the entrants at some of the schools were given the
opportunity of being tuberculin tested were continued. The purpose
behind this testing is that a positive reaction in a child of this age probably
means that the child has been exposed to infection at his home. The
positive reactors then are referred to the chest clinic, where they themselves
are examined and their contacts encouraged to attend for examination.