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assessed, and it would be difficult to persuade the public to accept a scheme
without proper scientific evidence to support it. The process is not without
some slight danger. When we deal with such diseases as smallpox and diphtheria
where vaccination and immunisation do produce immunity, we also
combine with it the isolation of the patient in hospital to prevent further spread.
We do not do this with tuberculosis, except to a small extent, so that we still
have to rely on case finding as the basis of control.
In order to test the efficacy of B.C.G. vaccination, an investigation was
started by the Medical Research Council in September, 1950. It is still going
on, but by December, 1955, all the children involved will have been followed
up for three years. In London, Manchester and Birmingham, 50,000 school
children were chosen to take part in the test. All were volunteers for vaccination
and in their last year at school. Each child in the last school term was given
X-rays and skin tests to determine the suitability for acceptance in the experiment.
Some children were given B.C.G. vaccine and others acted as controls.
It should be possible in due course to give a categorical answer as to the value
of B.C.G. This piece of research is unique; in no country or previous project
have cases been so carefully selected and followed up so closely upon such a
scale. Britain has been admired and praised for not rushing into B.C.G.
vaccination without due caution.
I have often been asked why we have not pushed B.C.G. vaccination here
in Twickenham. The reason is that we are awaiting the results of the Medical
Research Council trial which we hope will tell us whether the procedure is of
any use or not, and the best methods of using it.
By finding the infectious cases and keeping them away from children and
young adults we can prevent the spread of infection to the most susceptible
groups. We need more mass X-ray units, more sanatorium beds, more houses
for tuberculous families where the patient can be isolated; guaranteed work
for the stabilised non-infectious patient, and probably B.C.G. vaccination for
the young adults. Standards of nutrition are rising and should be kept high.
We might need extra workers in the health department to persuade everybody
to attend for X-rays, but with good resources, good health education and a
co-operating public, the disease can be wiped out.
THE DISABILITIES OF THE ELDERLY
In last year's report I gave a preliminary account of a research into the
disabilities of the elderly which I carried out jointly with Dr. Smith of Sunderland.
I am pleased to report the paper was accepted for publication in the
British Journal of Preventive and Social Medicine and appears in the July, 1955,
issue. I have a few reprints. Until this year no accurate account was available
of the diseases and disabilities suffered by the elderly as they appeared in the
day-to-day pattern of their lives. Dr. Smith was able to persuade 238 men
and women age 60 and over out of 550 living in Tunstall and Silksworth, where
the estimated combined population is 7,500, to submit to a thorough physical
examination. The sample covered barely half of the elderly residents in those
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