London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1904

[Report of the Medical Officer of Health for London County Council]

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the value of the experience as a test of class closure—although here it must be evident that closure
of classes helped.
In all these schools, however, measles tended to break out again and again, until the proportion
of children was reduced to a certain degree (down to 25 per cent.), and this necessitated an amount
of class closure, which was ruinous to orderly and continuous education, some classes having to
close as many times as thrice in six months, and many closures took place, both at these and other
closing schools, owing to false alarms.
In the non-closing schools, on the other hand, only at Maryon Park is any untoward amount of
measles to be noted, and here it is seen that a very large proportion of the children were unprotected
(53 per cent.), which fully accounts for the excessive number of cases, which even here does
not reach the percentage which was reached at Purrett-road.
It will be seen that this year's experience, therefore, does not show any great preponderance of
balance in favour of closing, even when closure is applied at the earliest opportunity. Under
present urban conditions measles will appear in a school and spread when the proportion of children
unprotected exceeds a third of the whole number, and will not subside until the proportion is
reduced to a fifth of the whole number. One thing certain is that closure can never take the place
of good hygienic school conditions and its corollary, teachers especially trained in school hygiene
with well-developed sanitary consciences.
The Spread of Measles as Affected by the Proportion of Children Unprotected.—An examination
of the table shows that measles in general may be expected to appear and spread in a department
when the number of children unprotected reaches about 33 per cent., and that usually,
except where special conditions obtain, it ceases to spread when the proportion is reduced to
18 per cent.
The Spread of Measles as Affected by School Conditions.—The enormous value of healthy
surroundings in school is shown by the fact that cceteris paribus the lighter, the airier, and the less
crowded a school the less is the spread of measles.
In the two temporary schools of Timbercroft-road and Deansfield-road, in spite of closure at
the very earliest knowledge of a single case of measles having occurred, we have the curious and
melancholy parallel of 81.5 per cent, and 90 per cent, of the children unprotected attacked, and
only 55. per cent, and 4 per cent, of total children left who have not had measles. These temporary
buildings are incapable of even fair ventilation (I have found 30 parts per 10,000 of CO2 in one), of
proper warming or hygienic class arrangement, and in view of the experience here gained it would
be well to insist upon a higher area of floor space per child than in permanent schools; while
there can be no doubt that the minimum of floor space per child in all Infant schools should be
at least as great as in the older departments.
The Spread of Measles as Effected by the Altitude of the Teachers.—We have seen that unless the
very first case of measles in a susceptible class is noted and reported closure of the class fails to
arrest the spread of measles, so that even here the attitude of the teacher is of prime importance.
It is unfortunate that a penny wise and pound foolish attitude has been forced upon teachers from
outside, and when imbued with the ideals of increasing their average attendance by every means in
their power, the rough and ready principle of accepting and retaining every child regardless of the
condition of its health is prone to prevail in spite of its short-sighted nature. In schools driven on
this plan much spread of disease is inevitable. When, however, as fortunately often obtains, the
teacher, in spite of opposition, insists upon being governed by the higher ideals which we are
learning to designate as the "sanitary conscience," measles is likely to spread to a much less degree,
and where this conscientiousness is united with special knowledge and training in school hygiene
it is probable that we have the greatest safeguard against the spread of disease it is possible to
have, and where this is combined with the best hygienic surroundings it is probable that the
conditions would be more effective than school closure in confining outbreaks to their smallest
The Spread of Measles from Class to Class in School.—A glance at the diagrams is
sufficient to establish the fact that more usually than otherwise the secondary attacks arising
from a single case fall in more than one class-room,and that the ideas obtained from a static survey

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