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To start with, in these cases where investigations were carried out
all the children in the school were examined. Experience showed that this
was not necessary and anything beyond the examination of the pupils
in the class or sometimes classes affected is now carried out only if the
more limited enquiry shows this to be advisable. The procedure then is
to tuberculin test the immediate contacts. Those who react negatively
have not been exposed to the tubercle bacillus. They then could not have
caused the infection in the notified case, nor will they have had the
infection passed on to them. Nothing further then need be done about
them. Positive reactions means that those children have been exposed to
infection sometime or other. These children are therefore invited to the
Chest Clinic where they are x-rayed and where if necessary, further
examinations are carried out. Although this procedure has now been
followed for some years, it is not felt that it has on any occasion led to the
recognition of the source of infection of the notified case, nor is it felt that
the practice has led to the discovery of infection amongst the contacts
which had been contracted from the notified case. Many of these contacts
have been found to give positive reactions. A number of them had to be
kept under observation for a while. There was in fact one instance in which
one of the contacts was found to be suffering from pulmonary tuberculosis,
but it was not felt that she had contracted the infection from the notified
patient.
There were during the year, five instances of either pupils or staff at
maintained schools being found to be suffering from pulmonary tuberculosis,
so that the question of whether or not investigations were necessary
had to be considered. The first was a teacher who had been at his school
for a short time only. Nevertheless, because he was infectious it was
considered advisable that all the pupils in the classes he took should be
tested. Out of the 255 pupils tuberculin tested, seventeen were found to be
positive. Of these, two were kept under observation for a while. The next
was a child of six. As he had almost certainly contracted his infection
from his mother and as he was himself not infective, no investigations
were necessary. The third case was a pupil who gave a history of illness
before coming to the district and so before attending school here. As she
was not thought to be infectious, no investigations were necessary. The
fourth case was a boy of six notified in November. He had probably
contracted his infection from his grandfather. As he was not infective
there was no reason to examine the school contacts.
In December a girl of six was notified; she was not infective but
because there was no history of contact with infection at home, it was
felt desirable her class contacts at the school should be examined.
3. B.C.G. Inoculation. Another contribution made by the school
health staff is by B.C.G. inoculation. The object of this is to raise the
child's resistance to infection so that he is less likely to succumb when on
leaving school he is more exposed than he has hitherto been, and in many
cases is subject to greater stresses which have a bearing on the lowering of