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147
Appendix i.
Measles.
Results of Early Closure of School Classes.
Measles is an infectious disease very fatal to children, and consequently
special efforts have been made to prevent the spread of
the infection and lessen the mortality.
Difficulty in dealing with Measles. Owing to the fact that the
disease usually begins like a common cold, that the rash does not
appear till the fourth day, and that Measles is very infectious in the
early stage before the rash comes out, the usual methods of isolation
generally fail to arrest the spread of infection, being adopted too
late to be of benefit.
Object of closure.—Like other infectious diseases the spread of
Measles is greatly assisted by the aggregation of children in elementary
schools, and it has generally been held by Medical Officers of
Health that if on the appearance of Measles in a school, steps were
taken not only to exclude the patients, but all contacts with the
patient who might be incubating the disease, its further progress
would be arrested. For this purpose, notifications have been obtained
from school teachers of children absent on account of Measles, and
when several cases were notified, indicating a decided outbreak,
steps have been taken to close the whole school, or the affected
classes. It was soon found however, that if closure was not effected
until several cases had occurred, it was practically valueless,
because all the susceptible children were infected before the class
was closed. The only way to make closure successful appeared to
be to close a class directly the first case was notified and so exclude
the children, who had already been infected by the first case, from
attending school when they were beginning to sicken.
System of closure adopted.—It was consequently arranged between
Dr. Kerr, the Medical Officer of the London School Board (now M.O.
for schools under L.C.C.) and myself, with the approval of the London
School Board and your Council, to divide this Borough into two
nearly equal districts, and in one of these to close any class in the
infant department of an elementary school immediately a case of
Measles was notified, and in the other only to adopt the ordinary
measures of excluding children from infected homes.
The investigation began in January 1903, and it was decided to
close in the following wards in the Bast District of the Borough;
Glyndon, Central, St. Margaret's, St. Nicholas and Eltham, and not to
close in the remaining wards in the western half.
On receiving a notification that a child was absent from school
on account of Measles, the Sanitary Inspector straightway visits the
house and enquires as to the grounds for thinking it is a case of
Measles, and obtains particulars. If the information as to the
diagnosis is not conclusive and no medical man is in attendance I