THE EXAMINATION OF TUBERCULOSIS CONTACTS
Authors: E. Ward
Journal: BMJ (1935)

As the years pass, defects in our tuberculosis schemes become manifest and lines for improvement are indicated, although there is always room for a difference of opinion as to what modifications are best.The routine examina- tion of tuberculosis contacts, persons living or in close contact with a known case of tuberculosis, was begun at Edinburgh in 1887, and still continues on much the same lines to-day all over the country.It is seldom that all contacts are examined.The examinees are selected, partly by doctors and health visitors on account of some definite defect, mainly by the patients themselves-a few adults who are anxious about their health or are persuaded by others to attend the dispensary or to stay at home to meet the tuberculosis officer-but the very large majority are children of school age, who often enjoy a day's absence from school for the purpose.These children are examined clinically, and occasionally radiographed. DifficultiesIt was thought that by the examination of all home contacts as soon as possible after the notification of a case of tuberculosis secondary cases in an early stage would be discovered, and, being early, would respond to treatment and not become sources of infection later.These expecta- tions have not been realized.Though it is true that some unsuspected cases in an early stage are discovered, their number is small; secondly, they do not necessarily respond well to treatment; and, thirdly, contacts who are healthy at the time of examination may become tuberculous later. SOME ILLUSTRATIVE CASESA boy of 10 was seen as a contact in August, 1928.He had always been delicate, but clinical and radiographic exam- inations were negative.Nevertheless, his brother had died from phthisis at 21, a short time previously, so this boy was sent to a children's sanatorium, where he remained for two years and three months.After leaving school he went to work, and remains at work to-day, but a skiagram taken in February, 1935, showed coarse mottling in both upper zones.Precautionary measures which might be called extreme have not prevented tuberculosis.Dr. Hebert has reported the case of a child of 9, examined as a contact in 1919, who subsequently attended regularly at the dispensary, being seen at least three times a year.At her thirty-ninth attendance she was found to have active exten- sive pulmonary tuberculosis.In January, 1919, a woman aged 43 with a positive sputum was seen, and was kept under observation and treatment until her death ten years later.Four years after this her daughter, aged 29, seen for the first time at her doctor's request, was found to be sliffering from acute tuberculosis, and died within two months.In this instance the contact, who was 15 when the mother was first visited, did not stay at horpe at any time to be inspected, and it is even then doubtful if measures taken during those fourteen years would have avoided acute tuberculosis in 1933.A woman of 37 with a negative sputum and scanty radio- graphic pulmonary tuberculosis was seen in March, 1926.Her daughter, then aged 13, was in good health, yet in August, 1933, seven years later, she suddenly developed a pleural effusion.She was found to have a somewhat extensive tuberculosis on the side of the effusion, and her sputum contained tubercle bacilli.A girl of 11 was first seen as a contact in July, 1921, and at intervals for three to four years, then not again, as she had passed school age, until April, 1934, when she was dis- covered to have advanced active disease.Another girl was similarly seen on September 19th, 1921, at that time 9 years old, and was similarly supervised.Now, in April, 1934, seen at her doctor's request, shie has extensive disease.