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44
in which the children are least able to meet it. It would be a great
gain if much of the attack-rate could be postponed to a later ageperiod;
and, in my opinion, the most effectual step that could be
taken to reduce the mortality rate from Measles would be the exclusion
of all children under 5 years of age from the infant departments of
elementary schools.
Measles in London only spreads seriously in classes under
5 years of age, except in certain better-class districts, as testified to
by the investigations of Dr. C, J. Thomas, the Assistant Medical
Officer (Education) of the London County Council; and as all our
experience leads to the conclusion that temporary exclusion, whether
total or partial, of school children under 5 years of age, when
Measles appears amongst them, will always fail, permanent exclusion
under this age is the only real solution to the problem.
Dr. Arthur Newsholme, the Medical Officer of the Local
Government Board, gave it as his view, in 1897, that experience
in administration always shows that attendance at school increases
the risk of importation of infection into homes, and he considered
that there was a high degree of probability that if children were
not admitted to school until after 5 years of age, the results would be
that fewer families would become infected, and the children of those
families still becoming infected would be infected on the average at
a higher age, with the result that fewer deaths would occur. As
Dr. Sykes points out, this experience is confirmed by the London
statistics, which show a diminishing mortality from Measles
coinciding with a diminishing number of children in recent years
attending the schools at ages 3 to 5.
It has been truly said that we should do nothing which is
calculated to arrest the development of the idea that the best place
for all children under 5 is a good home, and, moreover, that,
"there is in the natural relationship between mother and child, and
in the other influences of good home life, a moral and educational
power which it is of high national importance to preserve and'
strengthen." As a matter of fact, the very young child stands in