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154
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 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 cases 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 notificatian 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.— As the great majority of children excluded are
under six years, the interference with school attendance has not
been of a serious nature. It would probably diminish the mortality
from Measles, without prejudicing education, 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. But it is clear that until some measures such as are suggested
above be taken, very little result can be hoped from early school
closure after Measles has appeared in diminishing the spread of
Measles and the mortality of the disease.