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60.
required will be justified by the results obtained, and the next step is the extension of such schemes
for older school children. Meanwhile the investigation is being continued and it is hoped that it will
provide further Information about protection against tuberculosis.
During 1950 and 1957 further progress was made in the Tuberculosis Vaccines Clinical Trial. East Ham
and other areas co-operating with The Medical Reasearch Council in this extensive investigation to determine
the contribution which vaccination against tuberculosis can make to the reduction of this disease.
Beginning in September, fourteen year old children were invited to Join the investigation during
their last terms at school. By December 1952, more than 60,000 or these young people had volunteered to
participate. All were given a chest x-ray on entry and also a skin test to determine whether they were
eligible for vaccination. Those who were eligible were given B.C.G. vaccine, the best known tuberculosis
vaccine, or vole vaccine, a British vaccine which has been developed more recently than B.C.G.; others
were not vaccinated.
Since the trial began it has been the task of those co-operating in the work to keep the participants
under observatlon and detect any cases of tuberculosis which arise. Contact has been maintained with the
participants by sending each a postal form once a year, by an annual home visit by a health visitor, and
by annual chest x-rays. All these methods have been successful and only a very small proportion of the
young people have been lost sight of. However, the most important contact has been the visit to the home,
and the health visitors deserve great credit for the persistence with which this work has been performed.
In many of the houses visited, for example, it has been necessary to make repeated calls before anyone is
found at home. At these visits details of the participants health and of any known contact with tuberculosis
have been obtained, as well as other essential Information such as changes of address. The home
visits have also provided an opportunity to remind the participants of the object of the investigation and
have done much to assist their continued co-operation.
The chest x-rays have also been an essential feature of the investigation. These examinations are a
valuable health safeguard and ensure that any cases of tuberculosis or other chest disease which develop
can be promptly and adequately treated at an early stage. Besides these principal methods of follow-up
information has been made available from the chest clinics ln the areas concerned, and also from the
Armed Forces.
As a result of the intensive nature of the follow-up it has been possible to obtain Information about
the protective effect of the vaccines quickly and ln 1956 the first results were published. The findings
clearly showed that B.C.G. and vole vaccines both confer substantial protection against tuberculosis.
Local authorities ln England and Wales have therefore been encouraged to begin or increase the vaccination
of thirteen year old children who are now offered the vaccine ln all areas ln the united Kingdom. It is
to be expected that this widespread vaccination will produce a considerable reduction ln the incidence of
tuberculosis ln young people ln the future. This step forward ln preventive medicine has been made possible
by the co-operation of the local authorities who have done so much to support this investigation of
the vaccines.
The evidence of the protective effect of the vaccines is available so far only for a few years after
the vaccines have been given. There is still no certain knowledge how long protection lasts, and it is
desirable to know whether its protective effect will fall off within a few years or remain for a long time.
Accordingly it is hoped to continue the investigation for some further years. Apart from knowledge about
the vaccines other Information of considerable value to the understanding and prevention of tuberculosis
is likely to be obtained.
As time goes on the difficulties of keeping ln touch with the participants have tended to increase
especially when young people move from an original address. However, with the co-operation of the local
health authorities arrangements have been made to have the participants visited and x-rayed ln any part
of the United Kingdom to which they may move; similar facilities are available in many countries overseas.
A large proportion of the young people, over 90 per cent, continue to have a regular home visit and
response to the annual chest x-rays is still very satisfactory. In East Ham In 1967, for example,
65 per cent of the participants invited kept their x-ray appointment. When it is recalled that the Trial
has been going on now for over eight years, and that the participants are now over twenty, the response
is a tribute to the co-operation of the participants and to the able and conscientious work of the health
visitors."
MASS RADIOGRAPHY
The Mass Radiography Unit (6B) visited East Ham and conducted a public survey from 7th October to
llth November 1957 The Unit was accommodated ln the Town Hall Annexe and a total of 8,717 persons
4,218 males and 4?499 females - attended for examination. These can be classified Into the following
group:
General Public 5,244
Referred by General Practitioners 486
Groups from schools 147
Organised groups from factories,
offices, etc. 2,840
8,717