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Case X. This patient was sent to hospital for treatment as a
carrier and presented a diagnostic problem to the clinicians who
notified him eventually as a mild faucial diphtheria. He was a member
of the affected class who had never been immunised and was
found on 3rd October to be Schick positive. Two days later he was
given prophylactic serum. A repeat routine swab taken on 7th
October was found to be positive and he was admitted to hospital.
His condition was satisfactory throughout. His uncle, who worked
as a bus conductor, and lived in the same house was found to be a
carrier and was successfully treated at home before resuming his
employment
Case XI The source of infection introduced to this class before
19th September was never discovered, and things were settling bac
to normal when an interesting development occurred. A boy of six
years from the affected class where he sat next but one to Case No. I
was last at school on September 12th, the term commencing on 8th
September after the summer holidays. Symptoms of sore throat and
difficulty in swallowing developed soon after return from school,
and his neck gradually became swollen. A locum doctor who saw
the boy on the 15th was said to state that the boy was suffering
from mumps and "coccal" throat. Notes made on the boy's medical
record card on 24th September read " very severe streptococcal
throat infection with oedema. Made very satisfactory recovery with
penicillin, M. & B., Actinomycin (not all at once)." This boy was
medically examined, including an
E.C.G. and swabbed several times
subsequently without producing evidence of diphtheria, when on 22nd
October, about six weeks after his illness from which he had apparently
made a full recovery, the boy returned to his doctor with
paralysis of the palate on both sides. He was admitted to hospital
and notified as diphtheria (faucial—missed case). He made a very
satisfactory recovery in a few weeks. Further investigation did not
reveal the source of this boy's infection.
In all, in addition to the 11 cases described, 15 carriers were
detected. All but three of these 26 patients either were in the class,
had a sibling in the class or were very closely associated with a
known case or carrier. Three adult carriers were detected, and
only one of the patients was under school age. The 22 school
children involved attended six schools in all. Routine swabbing was
carried out on all pupils at the infants school and on the 1,000 pupils
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