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bacteriological confirmation of the diagnosis could be obtained in this
case either.
The school class in which the two cases occurred was one of
four in a modern single storey infants school with 127 pupils aged
between five and seven years in attendance. The children for the
most part kept to their own classes but mixed together during playtime,
assembly and for certain instruction, e.g. singing lessons.
Adjoining this school, separated by a wooden fence, are boys' and
girls' secondary schools whose 1,000 pupils are drawn from the same
catchment area. The infants share the senior school dining room.
Cases I and II both stayed to school dinners.
Immn sation state: The class concerned in the infant school
contained 35 pupils born between 1952 and 1953, and of these 17
were known to have been immunised by the immunisation record
cards held in the Health Department, 11 were said never to have
been immunised, while no record cards were held for the remaining
seven pupils whose parents could not remember whether or not
diphtheria immunisation had been carried out. Taking the school
as a whole 60 of the 127 pupils were immunised, 48 had never been
immunised, and the position regarding the remaining 24 pupils was
in doubt. No immunisation record card could be found for either
of the two cases.
On the day of notification teams of doctors and health visitors
inspected the throats and took swabs from about 100 contacts of the
children including the rest of the class and the patients' families and
close contacts. No further suspected cases were revealed by this
examination, and apart from one doubtful positive swab from an
older brother of a boy in the class, all the swabs were negative for
C. diphtheriae.
While awaiting the swab results, Schick testing wis carried out
on 31 pupils in the affected class because some 5 years or so had
elapsed in some cases since primary immunisation and in other cases
the immunisation state was unknown.
Case III. On 4th October an unimmunised girl from the same
class developed a sore throat. She had been under observation as a
contact and was admitted to hospital on the same day without home
treatment. Antitoxin was given at once and she was never seriouly.
ill. Virulent gravis organisms were grown from her throat
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