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medical officer should exercise medical supervision over these schools on the ground, inter alia, of preventing
the spread of infectious diseases, such as measles and whooping cough, by providing opportunity
for early diagnosis and the adoption of prompt preventive measures. It is therefore of the first importance
that a school nurse should make a daily visit to all such schools with a view to exercising strict
surveillance over the health of the children, taking steps to secure medical advice where required and
visiting absentees for the purpose of ascertaining the cause of absence. Where measles is concerned
the necessity of securing early information of its existence is paramount both from a preventive and
curative point of view. The services of a trained nurse in this connection are therefore an essential
factor in controlling infectious illness in such institutions.
Section (2) of the Ministry's Memorandum deals with grants for measles work under the Local
Government Board circulars of the 9th August, 1918, and 15th July, 1919, concerning maternity and
child welfare, "Whereby local authorities are allowed grants not exceeding one-half of approved net
expenditure on measles prevention and treatment.
Section (3) re-affirms the powers of local authorities to exercise their statutory powers for making
measles and German measles notifiable if they so desire, but it is pointed out that the Ministry could
only endorse such an Order if evidence is shown that the authority's organisation for dealing with the
following-up and proper supervision of measles cases is satisfactory. In this connection two London
boroughs have decided to continue the compulsory notification of measles, viz. : Lambeth, Paddington,
St. Pancras and Fulham.
The following scheme has been drawn up in consultation with the Education Officer, and approved
by the Central Care and Accommodation and Attendance Sub-Committees with a view to the more effective
control of measles in public elementary schools by expediting where possible the " voluntary " notification
of cases of the disease (in addition to compulsory notification where in force), thus enabling local sanitary
authorities to put into operation their arrangements for nursing provision and " following up " at an earlier
date than would otherwise be possible in many instances. The scheme involves close co-operation between
the school nurse, head teacher, school attendance staff, and the public health staff of the borough. It
is proposed in the scheme to pay special attention to the children under five years of age :—
Action by the school nurse.—The school medical officer will inform the nurse when a school or
group of schools in her district is threatened with measles, and she will be instructed to visit the
school (or schools) daily during a specified period with a view to carrying out the following
procedure :—
Scheme of
control of
Measles
in Public
Elementary
Schools.
(1) Obtain from head teacher the names and addresses of all children in affected classes
and of children under five years of age who are absent from school with suspicious illness or for
reasons unknown. She will supply the divisional superintendent (attendance) with this list
of absentees, if possible in person by noon on the day of her visit, if within reasonable distance,
otherwise she will forward it in an envelope marked " urgent."
(2) Inspect all children in the classes affected and all children under five years of age.
(3) In the event of any child being discovered to have symptoms indicating the possible
onset of measles, she will arrange for the child to be sent home at once in charge of an elder
brother or sister or some other responsible person, and will ask the head teacher to report
particulars at once on form 84 to the three officers concerned.
(4) In the case of any child suffering, in her opinion, from measles (including rash), she
will adopt the same procedure as in (3) above, and, in addition, will report the fact at once at
the borough medical offices.
Action by the school attendance staff—
(1) The school nurse will supply the divisional superintendent (attendance) daily with lists
of suspicious absentees from the schools under observation, and the school attendance officers
will visit these absentees at once.
(2) In cases where the school attendance officer discovers a case of measles, whether in
connection with these special visits, or during the course of his ordinary routine visitation,
Form A 5/191 should be forwarded at once to the borough medical officer of health and the
head teacher of the school concerned.
(3) If a child is suspected at the school attendance officer's visit to be sickening for measles,
he should call again in a day or so with a view to ascertaining whether or not measles has
actually developed. The rash appears within four days from the date of commencement of
illness.
Action by the head teacher.—It is important that the head teacher should give the necessary facilities
to the nurse and should report immediately on Form 84 to the three officers concerned, all cases, or suspected
cases, of measles as soon as information thereof is received (from whatever source).
The borough tnedical officer of health.—The foregoing procedure will enable the borough medical
officer of health to arrange for the health visitor to follow up cases of measles (particularly in children
under five) and to put into operation the borough scheme of nursing provision where necessary at the
earliest possible moment.
The number of cases of whooping cough reported as occurring among school children was much
lower than usual, viz. : 3,397, as compared with 11,671, 7,117, 8,595, 10,959,. 9,977 and 9,762, during
the years 1918, 1917, 1916, 1915, 1914, 1913 respectively. Whooping cough is compulsorily notifiable
in Greenwich, Holborn and Wandsworth. The order for compulsory notification of the disease in
Lambeth has lapsed.
The steady decline in the incidence of ringworm during the past few years has unfortunately been
arrested in the past twelve months, 3,447 cases having been reported among the children attending
Whooping
Cough.