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202
Annual Report of the London County Council, 1913.
Walworth.
If over 20 per cent, unprotected children in department:—
(i.) Exclusion of unprotected from classes affected,
(ii.) Exclusion of unprotected under 5 years throughout
the department.
If measles occurred in classes attended
by children over 5 years.
Closure of all classes attended by children
under 5
If measles occurred in classes attended
by children under 5.
Under 20 per cent, unprotected—
Exclusion of unprotected from classes affected
If measles occurred in classes attended
by children over 5 years.
(i.) Closure of class affected
(ii.) Exclusion of unprotected from classes containing
children under 5 vears
If measles occurred in classes attended
by children under 5 years.
Briefly the effect of the above methods is that in Bermondsey the procedure adopted in general
practice was applied ; in Southwark, W., the action taken was of a more stringent character ; and in
Walworth more rigid precautions still were put into force, including class closure.
The number of cases occurring in the experimental areas during the time the experiment has
been in progress is obviously too small to enable any final conclusions to be drawn from the figures
and a much longer experience of the measures adopted in these areas would be necessary in order to
form an estimate of the value of the experiment when judged on this basis alone.
The experiment, even during the limited period dealt with, indicates that it is possible to limit
the outbreak to the first crop in a greater proportion of cases by the methods adopted. There is,
moreover, no doubt that the experiment has been of material value in so far as it has served to keep
the teachers, care committees, attendance officers and others alive to the importance of the subject and
furthermore has enabled sanitary inspectors and health visitors to visit the cases at home more
promptly. These factors alone can scarcely fail to exert a salutary influence and must have the effect
of minimising, if not the actual incidence, the seriousness of the sequelæ which are so frequently
attendant upon an attack of measles. During the working of the scheme various improvements in
the machinery suggested themselves which indicate that it may be possible to secure even better
results. Since the summer holidays the number of cases was so small that it has not been possible to
test the variations which have been made. It is hoped that by the continuance of the scheme during
the year 1914 further light will be thrown upon the subject and that more conclusive results will be
obtained.
Whooping
cough.
The number of cases of whooping cough reported as occurring among school children has not
hitherto been annually recorded. During 1913, however, a daily return of the number of notified
cases of the disease was made, and it was found that throughout the whole year 9,336 cases were
reported from the schools. The quarterly distribution of the cases shews that the disease was
prevalent during the spring and early summer months. There is no doubt that the incidence of
w'hooping cough is subject to seasonal fluctuations in the same way as other zymotic diseases, and it
has been suggested that the rise and fall of measles and whooping cough are apt to occur more or less
concomitantly, although in 1913 it will be noted that whooping cough became more prevalent in the
second quarter when measles was beginning to decline after a period of activity in the first quarter.

The disease is very difficult to control in the schools, and such measures as have been tried by
the exclusion of healthy children in the classes affected, or the exclusion of children under five, have
not proved of very real assistance from a protective point of view, inasmuch as the disease is
infectious some time before the characteristic "whoop" is heard, and consequently innumerable
opportunities for the transmission of infection have existed before the sufferers are excluded from
school. In view of this difficulty head teachers are required by the regulations to exclude from
school during the prevalence of whooping cough all children suffering from bad coughs, irrespective
of whether " whooping" is detected. The exclusions for whooping cough cannot as a rule be
carried out sufficiently promptiy to prevent cases in the early and unrecognised stages of the disease
from disseminating infection. Although the precaution has been taken under certain conditions of
excluding children under five for protective purposes, it is necessary to undertake such action with
discrimination and with due regard to circumstances unconnected with school attendance. Whooping
cough has been compulsorily notifiable in Greenwich and Lambeth during the year, but in spite of
removal of the sick to hospital, quarantine of contacts for varying periods and disinfection of
premises, the control of whooping cough does not appear to have made any greater progress in
these boroughs than in the rest of London.