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It will be seen from the table that although the present outbreak is not yet
(April, 1924) at an end, it has already in comparison with the others cast a greater
burden of work upon the school medical service. Much of the increase, however,
is of course due to perfected organisation; for experience gained in the outbreaks
of 1920 and 1922 has resulted in a much larger number of visits to the schools being
made by the nurses and in a corresponding increase in the extent of limitation of
spread of the epidemic. During the nine weeks for which figures are available
11,198 doubtful absentees were reported to the attendance authorities for immediate
visitation; of these, 1,868 proved to be suffering from measles. No less than
425 children were found in school by the nurses to have measles or were excluded on
suspicion and turned out later to be cases of measles.
In the chart on page 92 the course of the three outbreaks is shown as seen from
the point of view of school notifications. The 1920 outbreak began in February,
rose to a maximum in March, commenced to fall about the Easter holidays, showed
a small rise after the holidays, and finally trailed off in July.
The 1922 outbreak was almost identical in character with that of 1920. It
also began in February, reached its maximum, however, in the Easter holidays,
showed a rather larger recrudescence after the holidays and again trailed away in
the summer term.
The outbreak in 1923-24, however, shows considerable differences; commencing
in November it did not reach its highest level until the end of January and
remained at the height of 2,000 cases a week throughout February and March to
April. From this diagram also, it appears that the present attack is bigger in bulk
than either of the two former outbreaks. It has been much slower in reaching its
maximum and the top of the wave has been flattened out. The change of type
is the result of two opposing forces. In the first place the intervals between the
last three waves have been distinctly prolonged; and secondly, in the present
outbreak more especially, the hindrance to the progress of measles which has
resulted from the strenuous efforts made to obtain early knowledge and early and
more efficient treatment for the children suffering from measles have greatly
reduced the mortality from the disease.
whooping The number of cases of whooping cough reported among school children during
cough. 1923 was 7,304 as compared with 10,340 (1922), 9,584 (1921), 8,779 (1920) 3,397
(1919) and 11,671 (1918). The school nurses paid special visits to 37 schools affected
with the object of advising the head teachers as to the means of prevention and control.
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