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those to whom infection has been passed on. The activities at the Chest
Clinic are important in less direct ways. Persons attend the clinic even
though not suffering from pulmonary tuberculosis and many, especially
children, attend until the clearing up in their chests of conditions which
would have developed some lung change which in turn would have rendered
them more liable to succumb to tuberculous infection.
The Mass X-Ray Unit which is run not as part of the Chest Clinic
service but by the hospital service, plays its part in prevention in the same
way by leading to the detection of disease at an earlier stage than otherwise
would have been the case, and so saving many from reaching the
infective stage in which they pass on trouble to others. About 20 per cent
of new cases are discovered by these means. This Unit was last here in
1956.
The local school medical and nursing staff, too, have some part to
play in the control of infection in different ways:
1. At some schools the school medical officers carry out the routine
tuberculin testing of entrants in the hope that examination of the contacts
of the positive reactors will lead to the detection of those who have
exposed the child to the tubercle bacillus. During the year, 816 children
were tested. Of these, 12 reacted positively. Six of these had had B.C.G.
inoculation; X-ray examinations of the others were clear. No home
contacts were in fact discovered in this way.
2. Whenever a pupil or adult worker at a school is found to be
suffering from pulmonary tuberculosis, the question of carrying out an
investigation at the school is considered. (i) A girl of fifteen was discovered
late in 1958 to be suffering from pulmonary tuberculosis. All of
the eight teachers who were X-rayed gave negative findings. Of the 65
children tuberculin tested, eight reacted positively. The examination of
these led to the recognition that one was suffering from pulmonary
tuberculosis; examination of her contacts led to the detection of the
infection in her father. (ii) The 25 contacts of a boy of seventeen at a
grammar school were tuberculin tested. Six were found to react positively;
all were found to be clear on X-ray examination. (iii) A boy at a
secondary modern school in August was recognised to be suffering from
pulmonary tuberculosis. He and his immediate contacts had all left
school at the end of the previous term. All 21 attended the Chest Clinic
for examination and were found to be clear.
There were three other school children who were admitted to local
schools from others outside the district and who had before transfer
suffered from tuberculosis, two of them from pulmonary and one from
glandular tuberculosis. None was infective at the time of transfer so
no investigations were necessary.
3. B.C.G. Inoculation. Another contribution made by the School
Health Staff is by B.C.G. inoculation. The groups selected for treatment
are children of thirteen years of age. This entails a separate examination
as this is not an age group at which a routine medical examination is