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deaths from this cause in 1960. This infection was responsible for the
deaths of ninety-seven persons in this district in 1944 and even of fiftyseven
in 1949.
Preventive Measures. Perhaps the chief of these is the early
recognition of infection in a person, preferably even before his lesion has
broken down and he has become infectious. The routine examination and
re-examination of contacts, especially family contacts of declared cases
carried out at the Chest Clinics results in the discovery of many cases,
some in the earliest stages. Then again the very ready facilities for the
examination of patients referred to the Chest Clinics by their own doctors
leads to the detection of disease in those who had not developed signs or
symptoms. This aspect of the work of the Chest Clinic is of the highest
importance.
The Mass X-ray Unit plays its part in prevention in the same way.
In the country as a whole, about twenty-five per cent of new cases are
diagnosed by this means.
The school medical and nursing staff continue to play their part in
controlling this infection:—
1. Tuberculin testing of the school entrants is carried out at some
of the schools. The object is to pick out those who react positively and to
encourage the home contacts of these reactors to attend the Chest Clinic
for examination, it being assumed that the child who reacts positively
has most probably come across the infection in his own home. On 280
children on whom the jelly test was used, two were positive; the x-ray
examination of the chests of these children was clear. 538 were tested by
the Heaf gun. Of the seven who reacted positively, six had had B.C.G;
x-ray examination of the chest of the other was clear.
2. Examination of Contacts. Whenever a pupil or anyone
engaged at a school is found to be suffering from pulmonary tuberculosis,
the question arises as to whether or not any investigations should be
carried out at the school. These will be possibly for two reasons : One is
to discover whether the infection might have been contracted from
anyone in the school. Nothing need be done on these lines if the source of
infection is known. This might be the case when there is a strong family
history of close contact with an infectious person at home. Similarly, if the
child has already contracted the infection before coming to live in this
district, or befors attending that school. But while investigations at the
school in such cases might not be necessary for this reason, they might
still be required for the other reason, which is to discover any pupils at
the school to whom the infection might have been passed on. This action
will be necessary only if the patient is considered to be infective. While
then in every case of this sort the question of whether or not investigation
should be made is gone into, not in all cases is it felt necessary that any-
thing should be done.