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176 Annual Report of the London County Council, 1910.
was found to be a carrier and excluded. Four further cases were notified from the infants' department,
the affected children having last attended school on 1st September (two), 2nd September and 8th
September. A final visit was made on 13th September, and cultures were taken from 28 girls and 50
infants ; amongst the former of whom another carrier was detected, and with her exclusion the outbreak
ceased. In this instance, school closure, i.e., the long summer holiday, had no effect in arresting the
spread of the disease or in limiting its area. Rather was the area extended, for while before the
holiday infants alone were attacked, both girls and infants were involved subsequently. It was not
until all the children had been bacteriologically examined and the carriers excluded that the outbreak
ceased.
Gar man
Measles.
During the past year the difficulty of controlling the spread of measles in London schools
has been increased owing to the frequent admixture of cases of German measles in the course
of the outbreak. As school outbreaks of German measles are infrequent, it is not easy to obtain
reliable information, but in a few schools the outbreaks have been almost entirely of the
German variety, and have been specially investigated by Dr. Hogarth and Dr. Letitia Fairfield. Apart
from clinical evidence, and so far as schools are concerned, it appears possible to differentiate an outbreak
of German measles from ordinary measles by the following circumstances. In an infants' department
the elder classes are attacked as frequently as the younger, and classes well protected by a previous
outbreak of ordinary measles are quite as liable to be attacked as classes not so well protected. The
disease does not tend to spread rapidly or even constantly throughout the school or department, and
isolated cases repeatedly occur in classrooms, whilst few secondary cases follow. Ordinary measles
does not produce an immunity against German measles and vice versa, and thus, during the recent
epidemic, many cases have been reported by teachers and parents as "second attacks" of ordinary
measles. The symptoms shown in school are different in the two diseases ; in the case of ordinary
measles there are signs of catarrh, bad cold, sneezing, coughing, while in the case of German measles
facial rash, feverishness, sore throat, headache are the symptoms which generally attract the teacher's
attention. Another important indication is the mildness of the attacks in many cases. The result is
that the parents, not having sought medical advice, deny that it is measles of any kind, and attribute
the rash to the consumption of water, ice, fish, and to other causes. In the case of German measles
this attitude of the parents is not unreasonable, and during the year, in some instances, the regulations
have been so relaxed as to allow children certified to have suffered from German measles to return to
school after 14 days' absence if certified by a doctor to be free from infection.
Continuation School Work in Hygiene} Etc.
The spread of knowledge of hygiene and the inculcation of a natural health conscience can be
carried on in the following ways :—
Elementary
Schools,
In the ordinary elementary schools by direct instruction to the children, but even more perhaps
by the example of the teachers and the steady moral pressure in the direction of cleanliness and the
correction of faults.
Evening
Schools,
in the evening schools the courses on health, home nursing, and infant care all have a direct
bearing on the hygiene of the community and show incidentally the great importance of correcting such
defects in children as may be revealed in the course of the medical inspection. The courses reach
students from the age of 16 and include a few of the younger married women.
Clubs.
Other courses, though usually of shorter duration, are held in many clubs, mothers
welcomes and similar institutions. These, being held in the afternoons, are very well attended by
mothers, who are able to bring their infants with them. In many institutions provision is made in
another room for the entertainment, during the lecture, of the children below school age. This provision
and the fact that the classes are held during school time when the elder children are from home
is an essential factor for success. A mother who has to leave children at home unattended naturally
will not attend any form of lecture, free or otherwise. These lectures have impressed on the mothers
in the poorer districts the importance of treating so-called minor ailments and have greatly facilitated
the work of medical inspection by inducing larger numbers of mothers to attend to receive advice.
Special Club
Classes at.
Elementary
Schools.
Teachers.
In some elementary schools special club classes of six lectures have been held soon after
medical inspections and these have been well attended and have rendered equally valuable aid.
Although such classes have increased and are widespread the task of impressing the parents
falls largely on the teachers in the schools, who are consulted privately by parents as to advice
given by the school doctor or care committee, and even on that given by their own doctor or by the
medical officers of hospitals or dispensaries. With a view to aiding teachers in dealing with such
problems arising out of medical inspection special courses of lectures have been given on the care of the
eyes, ears, teeth, etc., which were, however, only moderately attended.
Training
Colleges.
In connection with the medical inspection of students in training colleges arrangements were
made for medical officers to give three lectures on personal hygiene and the care of the body. These
lectures proved of personal interest and advantage to the students, and were the means of giving
information which will be of future use to them as teachers, as they have a more direct practical and
personal bearing and are quite distinct from the routine lectures in hygiene embodied in the
educational syllabus.
Syllabuses.
The following are examples of the syllabuses which were used in connection with some of the
foregoing classes:—
Clubs.—Infant care—six lectures on baths, clothing, food, infantile ailments, training of babies
care of the mother's own health.