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A girl (aged 7½ years) had attended Moreland school for two days with a mild
sore throat. On the third day (3.10.58) clinical diphtheria was diagnosed and she and a
child (aged 6) in the infant department of the same school produced a positive swab.
Throat and nose swabs were taken from all children in the classes concerned and,
in view of the extremely congested site, from the entire infant, junior and senior
departments of St. Catherine Laboure school. Close contacts were inspected daily.
Children with infection of the upper respiratory tract were swabbed and excluded
from school, absentees followed up and parents' permission sought for immunisation.
Children whose parents gave consent in the classes affected at the Compton and
Moreland schools, and in the whole of St. Catherine Laboure school were immunised,
and those who had not previously been immunised also received anti-diphtheritic
serum, special care being taken with children with an allergic history who received test
doses in the first instance.
On 10 November, 1958, and 12 November, 1958, two children of two years were
diagnosed as cases of clinical diphtheria. Family contacts were swabbed and, as one
aged 4½ years who attended St. Catherine Labouré school produced a positive swab,
swabbing of class contacts and the class of a sibling contact were carried out.
No direct connection was found between the cases in the first and second phases,
but it may be that one of the adult healthy carriers who lived in the same block dwelling
as the clinical cases initiated the second phase and was the missing link.
In the first phase 34 and in the second phase 14 positive swabs were obtained but
only 2 of each were considered to be mild clinical diphtheria. Of these 4 cases one
had not been immunised; there was no record of another being immunised, one
had received, in September, 1958, the first injection only of a primary immuhisation
course, and another had had primary immunisation in 1957 and a booster injection in
October, 1958.
Letters were written to parents of children in the affected schools, who required
primary or booster injections, using the incident as an illustration of the need to have
their children fully protected. Immunisation activities in other schools were pressed
ahead as far as possible.
Poliomyelitis
The extension of the offer of protection against poliomyelitis to everyone born
in 1933 or later necessitated the provision of special facilities for adolescents and young
adults who did not opt to go to their family doctor, viz.:
(i) Sessions at the place of work by a visiting team from the division, or a
doctor employed by a firm; 5 sessions, 237 attendances;
(ii) sessions at further education establishments by a divisional team: preliminary
arrangements made at 14 establishments, first session on 12 January, 1959;
(iii) evening sessions; 36 sessions, 765 attendances;
(iv) Saturday morning sessions; 7 sessions, 26 attendances;
(v) lunch time sessions (held at Holborn Town Hall with the co-operation of
the Metropolitan Borough of Holborn); 6 sessions, 1,513 attendances.
The most successful methods were (v) and (i)—415 persons attended one lunch
time session. Attendances at (iii) and (iv) were generally few.
Initial publicity for these facilities included the sending of letters to 2,628 firms in
the division. Of these 15 asked for the divisional team to visit and 5 firms made their
own arrangements with some assistance from the divisional staff. Many more asked for
publicity material.
Problem
families
'Field' and intermediate case conferences continued to be held and the divisional
co-ordinating committee met regularly. Co-ordinating conferences were run on the
principle of elasticity with the aim to secure the attendance of all who had personal
knowledge of any particular case. Family doctors are now always consulted before
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