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of a preventive nature, but preventive schemes vary with different age
periods, e.g,:-
In Infants and pre-School-Children we stress the importance of B.C.G.
vaccination, separating the Infant at birth from an active tuberculous
mother, routine X-ray examination of midwives, health visitors, day nursery
staff and foster parents, and periodic tuberculin testing with X-ray examination
of positive reactors.
Schoolchildren. Separation of active cases in the home, or if this is
not possible, arranging with the Children's Officer for the boarding-out of
the child, regular tuberculin testing and B.C.G. vaccination and X-ray
examination of the chest where indicated; X-ray examination of the School
Teachers and others with whom the child may be in contact,
Adolescents. Attention is paid to adolescents of the 15 to 25 age
period, whose morbidity and mortality rates, especially among females, Is
known to be high, B.C.G. vaccination of school leavers, students, teachers,
nurses, ambulance workers and factory workers whose tuberculin test is
negative is strongly encouraged.
CONTACT EXAMINATIONS,
The discovery of any "open" case-whether by Mass Radiography or
routine examination at the Clinic-involves the immediate Instigation of
a so-called "zone of hygiene" to discover the possible source of infection
and to minimise any further dissemination, A mass attack on "contacts" is
initiated, not only in the home but also, whenever possible, among the
working associates if a worker is involved. Where a teacher is concerned,
in close co-operation with the Medical Officer of Health the contact pupils
would of necessity undergo routine X-ray examination Attention is also
paid to adults, especially those whose work renders them more liable to the
risk of infection; periodic X-ray or Mass Radiography, tuberculin testing
and B.C.G. vaccination where indicated are encouraged. The assistance of
a full-time Almoner, especially in "contact" factory work, would be of
enormous value.
MASS RADIOGRAPHY.
It is felt that more adequate facilities for routine X-rays would
greatly enhance the efficiency of our preventive and case-finding programme.
The need for a fixed Mass Radiography Unit within reach of the Borough is
an urgent necessity, as X-ray examination of the chest must be repeated
at intervals during those years of life when the incidence of pulmonary
tuberculosis is known to be greatest if cases are to be detected at the
earliest stage; many hitherto unsuspected sources of infection may also
be brought to light,
THE CHRONIC SPUTUM-POSITIVE CASE.
An important problem in the prevention of tuberculosis is the chronic
sputum-positive case. Adequate training through the chest Clinic team can
do much, by securing the patient's co-operation, to minimise the risk to
others. We emphasise the need, as a preventive measure, for the patient
with a cough to cover the mouth with a handkerchief and to use a sputum
flask whenever possible. The care of the flask, the disposal of the sputum
and a high level of social behaviour in the interests of himself, his family
and the community are constantly being taught by our Tuberculosis Visitors,
It is, however, imperative that facilities should be made available for him,
from a social point of view, to shoulder this responsibility effectively.
The availability of "Remploy factories and workshops" for the sputumpositive
case would be a valuable asset. Where there are crowded home
conditions, especially with young children and adolescents, the provision of