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72
through the kindness of Mr. Robert Blair, Education Officer of the London
County Council, that during the seven years (1903 to 1909) the annual average
number of children under 5 years of age on the roll of the Elementary Schools
has steadily decreased, and the percentage of attendance has steadily increased.
It is improbable that an increased parcentage of attendance of a smaller
number of attendants should cause a diminishing mortality. In Table IV.
it is further shown that of the children scheduled annually in London the
percentage on the roll at ages 3 to 5 years has been steadily diminishing
in direct ratio with the fall in the mortality from measles. It is probable
that this diminution of the percentage of children aged 3 to 5 years
attending school, a fall from 41.0 per cent. to 31.7 per cent., is the cause,
or the main cause, of the fall in the death rate from measles. Children
aged 5 to 14 years have during this period been attending school in about
the same proportion, with a slight rise, namely, 97.2 per cent. to 97.5 per
cent, of the number scheduled at ages 5 to 14 years. That it is very
probable that the gradual diminution of the number of children under 5
years of age attending school is the cause of the diminished mortality is
supported by the diminishing death rate from measles at ages 0-5, when
calculated upon the number of children living at ages 0-5 by the Medical
Officer of Health of the County of London, as shown in Table V. It is
furthermore rendered most probable by that officer's chart of the monthly
variations of deaths from the mean of measles and whooping cough from
1891 to 1908, wherein it will be seen that the mean mortality of both
diseases commenced to fall about the end of the last decennium, and has continued
to fall through this decennium. (See Annual Report of the Medical
Officer of Health of the London County Council for the year 1908, facing
page 25.)
In a Report upon Attendance at Public Elementary Schools of children
under 5 years of age, made by the Medical Officer of Health of Willesden in
1909, he savs:—"Fourteen per cent, of all the children under five attending
the Infants' Departments of the Public Elementary Schools in Willesden caught
the infection of measles at school, and were the first to introduce it into
non-infected homes; 8.4 per cent. between five and six, 6.5 per cent.
between six and seven, and 4.5 per cent. between seven and eight similarly
contracted the disease. In the boys, girls, and mixed departments only 0.3
per cent. of the scholars between seven and ten similarly contracted the
disease."
The death rate per mille of measles increases in direct ratio with the centripetal
aggregation of population. In the smaller towns it is about one-and-half
times greater than in the villages, and in the larger towns it is again about
one-and-half times greater than in the smaller towns. (See recent Annual
Summaries and Reports of the Registrar-General.) In the face of such a fact,
it is impossible to contend that infants drawn together to a school centre are
not more likely to cause the more rapid sprtad of measles than if they played
together in the various streets where they reside. It is also impossible to deny
that the younger the children assembled together at school the more rapid the
spread of measles, and the more fatal the result.
Exclusion from School on account of Measles.
There are various degrees and kinds of exclusion of children from school.