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18
The discovery of six carriers in this group indicated the
possibility of a widespread carrier state, and it was decided to
swab the entire school of 350 children, including absentees and,
later, to extend the mass swabbing to the adjacent infants school
because of family contacts.
The policy to be adopted was discussed with Dr. T.J.B. Geffen,
Senior Medical Officer, Ministry of Health and Dr. C.E.D. Taylor,
Director of the Public Health Laboratory, Colindale, and it was
decided to control the spread of infection by removing carriers
as well as cases from the community by admitting them to hospital
as soon as possible This was particularly necessary since the
affected district consisted of working class dwellings, including
much Council property and consequently contained many large
families with children attending a number of different schools
This, coupled with the fact that many of the mothers were in
employment, rendered the maintenance of proper isolation at home
impossible. Children excluded on suspicion with strict instructions
to remain indoors were often found playing with others in the
streets.
After the initial stages Schick testing was abandoned, since,
with the very limited trained staff available, it was felt that
the information gained from the test did not justify the amount
of time spent as the large numbers involved would inevitably lead
to delay in carrying out more active measures. In the two schools
alone there were more than 600 children at risk and many of these
were from families with a large number of home contacts Schick
testing would have been of no assistance whatever in identifying
possible carriers which was the most urgent task facing us.
Passive immunisation with anti diphtheritic serum was not
generally given, for the same reason, but active immunisation was
offered to all for future protection although no immediate effect
could be expected. As the outbreak dragged on for a further four
months to the end of May it is certain that active immunisation
of this compact community at the outset was amply justified.
In order to detect carriers as quickly as possible repeated
mass swabbings were carried out. The first three of these were
of selected classes but the remaining sixteen covered whole schools
(including Staffs) and disclosed 6, 4, 0, 0, 6, 8, 5, 3, 0, 0, 0,
2, 0, 2, 0, 0 carriers Two consecutive negatives were obtained
from the infants school by May 3rd and from the juniors by June
2lst. In addition absentees (at one time amounting to 40%) home
contacts of carriers and of children excluded on suspicion were
swabbed at intervals of from 24 72 hours until three consecutive
negatives were obtained from all members of the affected family.