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101
have been infected by him. This still remains one of the chief activities
at a chest clinic, and the examination of these contacts is one of the
main ways in which new patients are discovered. Those at these clinics
possess in the x-ray machines aids which were not available to their
predecessors. There is too today, the mass x-ray unit, though this is run
as part of the hospital service and is not based on the chest clinic. The
mass x-ray unit which visits this district comes here once every three
years. The last visit was in the Summer of 1956.
The local school medical and nursing staff play their part in the control
of this infection. The school medical officers at some schools carry out the
routine tuberculin testing of school entrants. The purpose here is to
detect the positive reactor. Because it is assumed that a child of that
age who reacts positively and has therefore been exposed to infection is
most likely to have had that exposure in his own home, the presumption
is that there is in the home of the tuberculin positive entrant an infective
person. The adult contacts of these positive reactors then are invited to
attend the chest clinic for examination. During the year, 311 children
were tested; of these only 3 reacted positively. No home contacts were
in fact discovered in this way.
Then whenever a pupil or an adult worker at a school is found to be
suffering from pulmonary tuberculosis, the question of carrying out an
investigation at this school is considered. The extent of the investigation
will depend on a number of factors, such as the infectiousness of the
patient, and the opportunities he had to infect others. In some cases no
examinations of contacts are considered necessary. In most, the procedure
is to tuberculin-test the class contacts. Those who react positively
are X-rayed and if necessary, subjected to further examination. In other
cases it may be necessary to examine not only all the pupils at the school
but members of the staff. The clinical work is carried out by the staffs
of the local chest clinics.
During the year, a teacher at one school, a caretaker at another and
pupils of six other schools were recognised to be suffering from pulmonary
tuberculosis. In three instances it was not considered necessary to carry
out any investigations. In two the class contacts were examined; in
neither was the proportion of positive reactors high, and further examination
of those reacting positively did not point to any of them having
active disease. At one school the tuberculin testing of the thirteen-yearolds
as a preliminary to B.C.G. inoculation showed a very high proportion
of positive reactors. On this all the teaching staff were examined;
all were found to be negative. On the occurrence of the disease in an
adolescent girl pupil about the same time that an adolescent boy who had
been away from school for many months was then recognised to be
suffering from pulmonary tuberculosis, all at the school were examined,
including the non-teaching staff. Although two persons were being kept
under observation, by the end of the year no infectious person had been
etected. Two of the pupil sufferers at other schools were recognised only
at the end of the year so that the investigations at those schools were
earned out in 1959. On the other hand, early in 1958 investigations were
earned out of contacts of a pupil notified in December, 1957; the results