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15
Puerperal Fever.
7 cases of puerperal fever were notified in 1905, and 4 of these died.
Measles.
This disease has been much less prevalent in Bermondsey during 1905 than the previous
year. The number of deaths for 1905 was 59, against 136 in 1904.

This table of school notification also shows a diminution of cases, and shows March as the
period of greatest prevalence. The diminution is probably due to exhaustion of susceptible
material during 1904, and is probably also on this account only temporary.
The control of this disease is a constantly recurring question, and is a never ending source
of controversy by public bodies interested in elementary education. An interesting experiment
is being tried in Woolwich of treating a selected district specially. In one half of the district it
is attempted to suppress measles by vigorous class closure, and in the other individual exclusion is
the means adopted. A report on what has already been done has been incorporated in Dr. Kerr's
report to the Education Committee of the London County Council, up to the end of March, 1905,
but no final conclusion as to which is the best method has so far been arrived at, though a great
deal of useful information on the subject has been collected.
The general conclusion of the Medical Officer (Education Department) is that "probably,
exclusion of non-protected individuals will be the ultimate solution of the attendance problem in
face of a measles outbreak, and it is very doubtful whether exclusion of children, themselves
unaffected but coming from affected households, is required in any except the infants'
departments."
On examining Table IV. in appendix it will be seen that 57 deaths of the 59 occurred under
5 years of age. In other words, that while older children may be equally susceptible to measles,
it is not nearly so fatal to them. Any measure, therefore, which postpones the disease to a
period subsequent to five years will be valuable, and lessen the mortality. The large majority of
young children acquire infection at school, and it seems to me that the best method of preventing
spread of this disease would be to prohibit children attending school till they are six years old.
It is quite early enough to begin education, and anyone who goes into an infant department must
be pained to see young children of from 3 to 5 sitting in constrained positions, many of them
finding it very difficult to keep awake.
No child in Germany attends school till between 6 and 7, and it would be much better for
the health and eyesight of English children if they also were allowed to play in the open air till
this age and discouraged engaging in near work.
An endeavour is made to control measles in this district by excluding the patient for at
least one month, and the contacts of the first case in the household for 3 weeks, at the end of
which time the house and all infected articles are disinfected. When this is done a certificate is
sent to the school stating that this has been done. There has been no reason for altering this
plan during the year, but when the final report of the Medical Officer to the Education
Department of the London County Council, and the Medical Officer of Health for Woolwich is