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153
The death rates in the two districts during 1901-2 were nearly
equal. There has been a marked reduction in the death rate during
1903-5, but this reduction has been somewhat less in the closure
district than in the non-closure. The number of deaths, however, in
each district is too small to draw from them reliable comparisons.
There has been a striking reduction in the death rate from
Measles in the Borough during the last six years, both as compared
with the preceding years and with London during the same period.
This is shown by the following table:—

The figures previous to 1901 are exclusive of the part of the
Borough known as Eltham, but the Eltham figures could not
appreciably diminish the rate, though they might possibly increase
it, as the Eltham population was then less than one-fifteenth that of
Woolwich and Plumstead.
This remarkable reduction of deaths certainly has little relation
to school closure, having commenced before early closure was begun.
The death rate was naturally low in 1901, which succeeded a year of
high death rate. In January, 1902, was commenced the practice of
taking a card of instructions as to the hygienic treatment of Measles
to every house when a case was notified. The usual biennial rise in
the Measles death rate in 1902 was slight, and the subsequent years
have shown a continued low mortality. It seems reasonable to
conclude that the reduced mortality is a result of more hygienic
treatment of children suffering from Measles, resulting from the
instructions given by card distribution.
Why Closure has not been more successful.—Although closure of
classes appears to have had the effect of greatly limiting the increase
of Measles in the eastern district compared with the western, it must
be admitted that the total result of closure has been much less than
might have been hoped for. The reasons for this are not far to seek.
There is no satisfactory system by which a teacher becomes aware
of the cause of the absence of a pupil. If no note is received from a
parent, she is not allowed to send a child to the house, but is usually
dependent on a hearsay report from any child who lives near. The
result is that, even when the cause of illness in a child is known at
home, it is frequently not known at the school till the expiration of
the ten days incubation period, during which closure should take
effect to be of value. The obtaining of early information depends to
a large extent on the interest and diligence of the head teacher in
excluding cases of infectious diseases ; whereas some teachers, even
without closure, have been most successful in checking the spread
of infection, from others information is seldom obtained until several
cases have commenced.