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65
culosis services are concerned, it has crystallised some ideas tliat
many ot us have held and, in this Borough, have endeavoured
to put into practice, with special reference to the need for its
co-ordination and integration with other medical sources, both
preventive and therapeutic.
The necessity for a much wider conception of the services in
the interests of the patient and the national economy have always
been one of our main objects. It is satisfactory to note that our
pioneer conception of the Chest Clinic and its changing functions
is being widely adopted. Its future recognition as the basis of
a complete Chest Service being closely linked up with—
(a) A Mass Radiography Unit for the detection of early
cases of pulmonary tuberculosis and other intra thoracic
diseases, and
(b) Inpatient Services in the form of Chest Units and
Sanatoria, cannot be over emphasised.
The further close affiliation of such a Chest Service with a
good Rehabilitation Scheme and a complete Social Service Department,
will go far towards our aim for a wider conception of the
Tuberculosis Service in the best interests of the Tuberculosis
sufferer, the community and the Public Health.
It is customary to comment on certain outstanding features
and impressions on the work of the year, and on this point I propose
to make a few comments this year chiefly on childhood
tuberculosis,non-tuberculous sub-acute pulmonary infections simulating
pulmonary tuberculosis, and bacteriological investigations
in pulmonary tuberculosis.
CHILDHOOD TUBERCULOSIS.
The number of children under 15 years of age suffering from
pulmonary tuberculosis has, I think, definitely increased during
the War years throughout the country. In 1939 we had 10
children notified and in 1945 the figure has risen to 24. The bulk
of our cases have been those of enlarged hilar glands, but in
addition pulmonary lesions of varying degrees have presented
themselves. I think contact infection has played an appreciable
part in the increase. The dearth of accommodation in institutions
has probably played an appreciable part here.
Any scheme for preventive inoculation of the childhood
population deserves serious consideration. Enquiries into recent