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excluding cases af infectious disease, whereas some teachers, even
without closure, have been most successful in cheeking the spread
of infection, from others information is seldom obtained until several
cases have commenced.
In addition to this, parents do not call in medical attendance in
about half of the cases of Measles that occur, and consequently are
often ignorant of the existence of the infection, and probably in
many cases are willingly ignorant.
It is no wonder then that early and satisfactory information of the
occurrence of cases is often not received. In many instances the
first case in a class is not heard of at all, and more often still it is
not notified until too late to be of service, viz., until the first crop of
cases has begun to sicken, and have attended school in an infectious
state.
What is required to make closure more successful is improved
means of gaining early information of the occurrence of cases of
infection. The school teachers have not the time to do this
satisfactorily. Probably it could best be done by making a notification
of all infectious diseases compulsory on parents, and throwing
upon them the onus of becoming aware that the disease was
infectious. This would no doubt involve the provision of medical
attendance free of charge for diagnosis purposes. But, a useful, if
less complete means of gaining the necessary information would be
the provision of trained nurses to visit immediately any children
absent from school and to report any suspicious eases, which could
then be visited by the School or Borough Medical Officer. Such a
staff would be beneficial in many ways as health visitors.
Difference of incidence on the east and west districts.—It has been
seen that in the two years preceding the enforcement of early
closing, Measles was much more prevalent in the east district than
in the west, viz., as 21.3 to 15.4. Whether this was the normal
condition of things before closure began in the east district I have
no means of knowing, as there are no records of the notification of
Measles in Woolwich and Eltham parishes prior to 1901. Certainly
it does appear as though there was a less tendency for Measles to
spread when it occurs in some of the schools in Woolwich parish
(which is included in the west district) than in Plumstead parish
(which comprises the chief part of the east district).
Conclusion.—Before finally deciding that early closure has
succeeded or failed, it seems desirable to pursue the investigation
yet farther. As the great majority of children excluded are under
six years, the interference with school attendance is not of a serious
nature. Indeed, it would probably diminish the mortality from
Measles if children were not allowed to attend school at all until
they were at least five years of age. There is no doubt that in a
large proportion of cases the infection of measles is contracted at
school and brought by children attending school to the younger
members of the family not attending, among whom Measles is so
fatal.
Now, obviously, if the age of school attendance were raised
by one or two years, the number of families of young children, none
of whom attended school, would be increased in proportion, and a
large number of young children who are now exposed to the risk of
infection would be comparatively safe.