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Report of the Medical Officer of Health.
33

Thus of 1,461 houses invaded in these districts multiple cases occurred in 709. In Paddington
there were, in addition, 43 cases in an institution.
The measures adopted for the limitation of measles prevalence include those taken in the
schools, mainly by the school authority, and those taken in the homes. Nearly all the reports of medical
officers of health tell of the closing of classrooms, or the exclusion of children under five years of age
who had not been protected by previous attack, when measles has appeared among the scholars.
Many of the reports show that the homes of the sufferers are visited by women sanitary inspectors,
health visitors, or voluntary workers, who endeavour to ensure that such precautions are taken as are
possible. In several reports the desirableness is discussed of raising the age limit of school attendance
so as to exclude children under five years of age on account of the frequency with which measles spreads
among the children attending the infant department. The extent to which measles thus caused gives
rise to other cases in the homes of the school-attending children was well shown in the report of Dr.
Butler, the medical officer of health of Willesden, for the year 1907. This report deals with 2,599
cases occurring in that district, of which 2,038, or 78 per cent., were due to infection in school or
to infection introduced into the homes by the school-infected children. It is well to mention here
that knowledge of measles cases is mainly obtained from the schools, and hence the remaining 22 per
cent, must not be thought of as including more than a proportion of the cases of measles occurring
in the district, and which had no association with attendance at the elementary schools. Of these
2,038 cases, however, as many as 1,859 were due either to infection in the infant department or to
infection in the home received from children thus infected. Those actually infected in the infant department
constituted about one-third of the 1,859 cases, and these children infected the other twothirds.
The remainder of the 2,038 cases, 179 in number, resulted from attendance in the senior
department, about one-quarter of them being actually infected in the school, and in turn giving rise
to the remaining three-quarters who were infected by them in the homes. Dr. Butler's figures
demonstrate the large part which the infant department plays in the causation of known cases of
measles in Willesden.
If infants did not attend school, or, indeed, if there were no school attendance, it does not follow
that any large proportion of the children who are now infected directly or indirectly through school
attendance would ultimately escape attack by measles, but every circumstance in life which leads to
the aggregation of children undoubtedly increases the opportunity for infection early in life, when
the fatality of measles is highest. The effect of increase of aggregation would, in fact, if tested by
the figures for a series of years, be manifested more by increased incidence on the early years of life
than by increase in the amount of measles generally.