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3. Reduce the more intimate grouping during lessons, or
preferably cut it out altogether temporarily. In this
particular school, which was a modern one both in
education and outlook, this friendly, informal, intimate
system was extensively practised.
4. The last of the four most important items is largely a
matter for the parents, it is to obviate the attendance of
early and missed cases. Last year I analysed the interval
between the last attendance in school and the appearance
of the rash. I found that 12 children were actually in
school on the day of the rash, one was in school the day
after as well, and one was even in school for two days
after the rash had appeared. Bearing in mind that a
child is infectious two days before the rash comes out,
there is no need to look for an obscure source of infection
when cases are loose among the school children.
It is gratifying to be able to record that at the time of
writing this report all these measures, together perhaps with a
raised herd immunity, have succeeded in bringing the incidence
of Scarlet Fever in this Ward to normal proportions. What part
herd immunity plays in this story is impossible to discover, but
it is interesting to observe that if one looks back a few years,
one can see the same phenomena at work in other Wards with
other schools as the storm centre.
It is opportune here to record the cordial relations between
the teaching staff and the department. Without the close
co-operation of the head teachers, as well as the class teachers,
our efforts could not be effective.
Measles. There were 721 cases of Measles during the year.
The biennial characteristic of Measles epidemics is now scarcely
discernible, though reference to the table on page 48 will serve
to remind us that it was at one time a clearly marked
phenomenon. We have had almost epidemic numbers of cases
every year since 1940. Measles continues to be a mild disease
and it may be that we ought to be grateful that the incidence
of this disease is high while it is so mild, as it thus maintains
at a high level the immunity of the population. The report of
the Ministry of Health for 1949 contains reference to an outbreak
in one of the islands of the Dutch East Indies in 1948,
where out of a population of 120,000 persons some 20,000
persons were attacked, with a death rate of 1 in 20. This seems
to show that the virus of Measles under favourable conditions
can still be an enemy not to be despised.
Out of the 721 cases notified there were no deaths.
In addition to losing its biennial characteristic there has
been a rapid fall in fatality. These changes have attracted the
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