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improvements in the manufacture of B.C.G. vaccine as the means
of acquiring active immunisation is worthy of serious consideration
for the tuberculin negative infant or child contacts, where
separation from the source is impracticable, and even in children
and adults who are still tuberculin negative.
Primary Tuberculosis, which is the principal condition we
meet in children, is the disease which follows the first infection
by the bacilli. Briefly, we encounter in childhood at the Clinic—
(a) Uncomplicated primary infection followed by calcification
and quiesence,
(b) Complicated primary infection :—
(a) Epituberculosis (so-called) with either—■
(1) A non-ceseating pneumonia, or
(2) Segmental collapse following stenosis of a
bronchus, due to a mediastinal gland. The
collapsed area usually re-expands following
treatment.
(b) In a few cases cavitation may occur in a primary
lung focus.
The post-primary tuberculosis in childhood may show either
a haematogenous spread (acute or chronic miliary tuberculosis)
or a bronchogenic type, especially in adolescents. Of the latter,
during and since the War, we have seen all too many,—the socalled
acute adolescent phthisis with a bad prognosis.
Pleurisy with Effusion in Childhood.
The War years have shown an appreciable number of these
cases at the Clinic. The lymphocytic fluid with a characteristic
exudate cytology, usually clears up with a full sanatorium regime,
and the prognosis is usually good, following a complete course
of treatment. Without treatment, pulmonary disease is much
more likely to ensue.
Erythema nodosum in childhood.
We have had quite a number of these cases with recent
primary tuberculosis. Whilst this may be due to other causes
than tuberculosis, the latter must be carefully excluded.
Phlyctenular conjunctivitis also demands a careful investigation
to exclude, in the first place, primary tuberculosis.