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Special Investigation - Tuberculosis amongst School Children:-
The following report by Dr. Hugh Ramsay, Tuberculosis Officer
in Walthamstow for the Essex County Council, is of the utmost
interest and importance.
The investigation is possibly the first of its kind in the
Country and was carried out by your Committee and the Essex County
Council jointly.
(1) In November 1942, a school teacher at Public Elementary School
"A" was found to be an open case of Pulmonary Tuberculosis.
(2) A certain number of children attending that school, who were to
a varying degree in contact with the teacher, were in consequence
examined at the County Tuberculosis Clinic in order to discover how
many, if any, were infected with the disease.
Children' attending another school "B", were examined as a
control group.
Both groups of children were examined by X-ray screening,
X-ray film, and the skin patch test.
(3) In assessing the results, a small number of children known to
be contacts of cases in their homes have been eliminated.
(4) No child In either school was discovered to be definitely
suffering from Tuberculosis in a recognisable clinical form, with the
exception of one boy at school "A", already under observation. There
is a history of home contact in this case. There was one doubtful
case, a child attending school "A" in which Dr. Sheldon and I both
felt that the X-ray evidence was conclusive of primary infection of
the right lung. Further developments and a negative patch test on
two occasions made it impossible for us to accept this case as proved.
The case remains under observation at the Dispensary,
(5) A few children showed X-ray evidence of simple pulmonary catarrh
They were examined fully at the Dispensary and the benign nature of
the condition confirmed. In one of these children I am of the
opinion that there might be an underlying Bronchiectasis. The child
is still under observation and further investigation will be arranged
if necessary.
(6) Three school tcachers accompanying the children were X-rayed.
One, from School "B", was found to have early bilateral pulmonary
Tuberculosis but was not an infectious type of case, and therefore
the children at the school should not have suffered any risk of
infection. The patient was examined at the dispensary, treatment
was arranged and the patient has responded very well. This is another
example of the vital importance of X-ray examination in the early
diagnosis of pulmonary disease.
(7) As regards the actual results of the investigation of the
children as a whole, the following points are of interest; A positive
Patch Test, with X-ray evidence of a healed primary focus, or either
event separately was taken as indicating infection. The Patch Test is
not quite so accurate as the intradermal Mantoux test, and X-ray may
show a definite calcified primary lesion in the lung without the Patch
Test being necessarily positive. Also, the test may be positive without
there being evidence of lung infection, there may be a primary
focus not visible on ordinary X-ray of the chest or the focus may of
course be situated elsewhere.
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