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of the isolated arrangement of classrooms break down in view of the dynamic methods of infant
school organisation, in which sections of classes are combined for various purposes. It is probable,
however, that in well-ventilated and organised schools the spread takes place more outside school
hours than in the actual schoolrooms where the children are under constant supervision. Thus at
Maryon Park (diagram XVII.) the infection spread from babies, not to babies, but from babies to the
older children whose duty it was to superintend the comings and goings of the babies.
GENERAL CONCLUSIONS.
The general conclusions which the inquiry seems as a whole up to the present to justify are:—
1. Measles at present in London only spreads in classes under 5 years of age, except in certain
better-class districts. Seventy-five per cent, of children above 5 in Infants' Departments are
protected.
2. Measles tends to spread whenever a class accumulates unprotected members to the extent
of between 30 per cent, and 40 per cent., and when spread has begun it continues until the
proportion is reduced to between 15 per cent, to 20 per cent, unprotected.
3. If children under 5 were excluded from school, closure for measles would not be necessary
for some time in London, except in one or two special districts; if, however, this were successful in
postponing attacks, the question would again become acute in a few years.
4. To deal efficiently with measles accurate knowledge is required; the measles history should
be elicited for each child on admission to school. This should be done universally; if notification
to School Authority was made compulsory on every parent whose children attended school, our
hands would be greatly strengthened. Unless the amount of susceptible material is fairly accurately
known for each school, we shall only be working in the dark as heretofore, and nothing of any
value can be expected to accrue from our methods.
5. To effect any useful purpose school closure must take place before the "first crop" falls.
The old practice of waiting until the attendance fell to a certain limit was useless in arresting the
spread of measles, and did absolutely no good.
6. The means of arresting spread of measles other than school closure are of enormous
importance; to name two—sanitary buildings and training of teachers; these two factors probably
have the greatest effect of all in determining the extent of spread of an outbreak.
7. Deaths often occur from ignorance on the part of parents. Circulars should be sent out
wherever measles has appeared in a class (i.e. on the incidence of the first case) begging mothers to
notice colds, and upon the slightest suspicion of such symptoms to keep the child at home for a day
or two. In this way measles would probably be checked to a far greater extent than has been
effected by any other means. Instances have come to our notice where heartbroken mothers have
stated that, had they known, they would have treated colds seriously of which they took no
note, and thereby their children's lives would have been saved. I suggest that circulars be thus
used during next year in Woolwich.
8. Measles never spreads in the Boys' and Girls' Departments. There is no need to exclude
children from infected homes who attend the upper departments. As a result of our inquiries, this
has actually been carried out at Brighton, with satisfactory results.
9. There is too great a tendency to look at things from an "attendance" standpoint; this is
one of the greatest evils with which we have to contend. The withdrawal by the Board of
Education of Article 101* was the greatest piece of official folly ever perpetrated. If a whole
department is closed the average attendance is not affected ; but if on the score of health a single
class is closed by order of Sanitary Authority, or by the Council's Medical Officer, it is supposed
that the attendances are missed, and the effect upon the average attendance and consequent grant
is enormous. We thus have great difficulty in carrying out our measures, as much opposition is
often encountered to the necessary closure of a single class, while the unnecessary closure of a
whole department is gladly borne or even welcomed.
10. This is an economic question which is not one of health at all; and when attendance has
fallen to a certain percentage at which the loss of grant is so severely affected, the department
should be automatically closed independently of the question of health. This percentage ought to be
worked out.