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200
Annual Report of the London County Council, 1913.
Easter when "scheduling" is in progress. As noted in last year's report there results a depression
of the curve of measles notifications during this scheduling time and there is a corresponding rise
when normal visitation of absentees is resumed after Whitsuntide.
Although the methods of control referred to above, under satisfactory conditions, are
effective, it frequently happens that the first case notified is subsequently found to be one of a series
of cases of the first crop, so that exclusion, when carried out, is too late to prevent the final group of
cases and the exclusion carried out with a view to preventing the first crop from falling in schools
becoming abortive.
The following requirements are, therefore, essential if the spread of the disease is to be
controlled.
1. Immediate and early notification of the first case in the infants' department or
class.'
2. Accurate knowledge in regard to the measles history of the children in the various
classes.
3. Segregation of susceptible children during the period of exclusion.
To demonstrate how far it is possible to secure the above conditions an experiment has been
carried out during the year in the electoral areas of Bermondsey, Southwark W. and Walworth with
the object of obtaining prompt visitation of all children absent from school, and of furnishing the
School Medical Officer with immediate notification of the first case in each class. In order to carry
out this experiment satisfactorily the co-operation of teachers in infant schools and attendance officers
was of great importance, and, in this connection, opportunity is here taken to express appreciation of
the assistance given in this way.
The special procedure adopted was to classify the infant absentees in two groups comprising :—
(1) Infants who were absent from school from Friday afternoon to Tuesday morning
inclusive. The head teachers were requested to report particulars of these absentees on a
special post-card to the divisional superintendent by noon on Tuesday morning. The
absentees were visited on Wednesday.
(2) Infants absent from Tuesday afternoon to Friday morning inclusive. These were
noted as usual by the attendance officer at his routine visit to the school on Friday morning,
and he visited their homes on the Monday to the Wednesday following. Precedence in
visitation was given to infant absentees over children in the older departments.
Whenever an attendance officer discovered a case of measles full particulars, including the
date of rash, were telephoned to the Public Health Department, and the School Medical Officer was
thus in a position to take more expeditious aud consequently more effective action than would otherwise
have been possible. By these means it was hoped to obtain the notification of the existence of
measles in all cases within a week of cessation of school attendances. This, if achieved, would
constitute a great advance upon the usual practice by which it is possible for a child suffering from
measles to be absent for 16 or 17 days before notification takes place.
The detailed analysis of the working of the scheme which is given in the following pages
covers the period from the beginning of the year to the end of the summer term during which period
the bulk of cases occurred, i.e. 694. The number of cases reported during the Michaelmas term,
namely, 61, was too small to be of any statistical value. Primarily it will be of interest to set
out in tabular form the results of the special maasures adopted to obtain early notification, in so far
as their bearing upon the action taken is concerned.

It will be observed that preventive action either by means of the exclusion of unprotected
children or closure of classrooms was taken on 190 occasions, and that in 71 cases, or 37 per cent., of