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saving in school attendance and showed also that the measles death-rate might be
minimised. By means of advice cards there had been accomplished a gradual education
of parents to a sense of their responsibility and to the seriousness of the disease. The
principles deduced from the enquiry were of sufficient weight and importance to justify
their application to all the infants' departments of the public elementary schools in the
Metropolitan area. They were also recommended generally by the Local Government
Board.
The procedure adopted was that the infants' head teacher made enquiry as to the
measles history of each pupil on the roll, and of every child newly admitted to the
department, if a child had already had measles, this was recorded in the attendance
register by the letter 'M'; if the child was not known to have suffered, this was noted
by the letter 'O.' If a child with a negative measles history contracted the disease before
leaving the infants' department, a suitable alteration was made in the register. The
record thus established served to show at any time the proportion of children protected
by previous attack to those who were unprotected and liable to attack when exposed
to infection, and it was upon this knowledge that any action was based. Immediately a
case of measles occurred in the department, a card was distributed to each of the unprotected
children in the classroom in which the patient was attending. This card
informed the children's parents or guardians that, as a case of measles had occurred
among the pupils in the children's class, it was possible that they might have contracted
the disease, and the parents were requested to pay particular attention to the state of the
children's health during the following three weeks, and upon the slightest sign of
illness to abstain from sending them to school. The case was then reported to the Medical
Officer (Education) with particulars as to the relative numbers of protected and unprotected
children in the room. The measles returns from all schools were reviewed daily
at the head office, and when, in the opinion of the doctor, closure of a classroom would
tend to check the spread of the disease, instructions were given to the head teacher, who
immediately sent home the children in the affected classroom, after distributing a card of
warning to parents. Unfortunately, when closure took place, all subsequent events
passed out of knowledge and the control of the outbreak by home visiting and advice
on the part of the local Medical Officer of Health ceased. The school remained the one
channel of information concerning measles and in the absence of school attendance the
control over the death-rate given by this knowledge was lost.
The control of measles in London schools continued to be the subject of serious
consideration. For example, a scheme was devised in 1913 by which it was sought, with
the co-operation of attendance officers and head teachers, to secure notification of the
first case in school within a week after the sufferer's last day of attendance.
In accordance with an Order of the Local Government Board dated 27th November,
1915, measles and German measles became compulsorily notifiable diseases on
1st January, 1916. With the object of deriving full benefit from compulsory notification
in connection with the control of measles in the schools, an arrangement was made
with Dr. Davies, the Medical Officer of Health of Woolwich, whereby full particulars
of all cases of measles notified under the Order were at once reported to the School
Medical Officer in order that immediate steps might be taken at the school concerned
to limit the spread of infection. As a tentative measure the principle of class closure for
short periods, instead of merely excluding those children who had not previously
suffered from measles, was adopted in Woolwich with a view to discovering whether
by such means a greater control over the spread of measles in school could be secured.
The Order relating to compulsory notification of measles was rescinded by the
Ministry of Health in December, 1919, and, while this action was no doubt justifiable,
it became the more necessary that close watch should be kept upon measles in the
schools, and special measures were approved by the Council having this object in view.
The Ministry of Health pointed out that various criticisms had reached them as to
the ineffectiveness of the Order of 1915 and that it had been concluded that compulsory
notification was not the best method of dealing with the problem of the control and
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