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after admission. The swabs taken before she became ill had been
negative.
Case IV. The next day another six-year-old girl from the class
was found on a routine visit to be suffering from sore throat with
slight exudate on both tonsils. She was admitted to hospital where
she was given antitoxin. The diagnosis was subsequently confirmed
bacteriologically. She suffered a mild attack only. This patient had
received a single dose of a combined diphtheria and whooping cough
vaccine over five years before.
As a result of this development, it was decided to close temporarily
the affected class and to administer prophylactic serum to its
nine remaining Schick positive members. It was also decided to
re-swab the affected class and home contacts and to Schick test and
swab the pupils in the remaining three classes of this school. The
school staff was included in the investigations.
Case V. On 7th October diphtheria was diagnosed in a girl of
12 years whose brother was a classmate of the four known cases.
This boy had already been swabbed twice and proved negative, yet a
repeat swab taken on 7th October was positive, but although he was
never immumised according to available records, he did not develop
the disease, perhaps because he had been given prophylactic serum
two days before when his Schick test was found to be positive. His
sister had never been immunised either and had a severe attack, from
which she eventually made a good recovery. She had not been to
school since 29th September, but fortunately no cases or carriers
were revealed amongst her classmates on routine inspection and
tabbing.
More carriers were now being detected including the original
doubtful positive swabbed on the first day, and three more members
of his family, including his mother, whose swabs were previously
negative. The econd sweep through the affected class revealed three
carners amongst the pupils, two of whom had received prophylactic
serum a few days earlier as a result of the Schick test.
Hospital treatment was arranged for the treatment of carriers,
but as the demand for beds for cases, suspected cases and carriers
grew. accommodation became scarce, and it was decided to isolate
and treat healthy carriers at home where conditions permitted, and
with the co-operation of the family doctors.
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