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134
Annual Report of the London County Council, 1911.
Removal to hospital in the case of measles would probably have scarcely any effect in preventing
secondary cases arising as the complaint is most infectious in its very early stages, when it is characterised
by catarrhal symptoms, and when, in most cases, the disease would not have been diagnosed. Consequently
any susceptible contacts with the patient at that time would have become infected before
removal to hospital. It is very probable, however, that the care and attention bestowed in hospital
would have the ultimate effect of mitigating the type of the disease and preventing serious developments
which so frequently ensue—such as suppurative eye and ear disease, broncho-pneumonia, or bronchitis,
and the debility which often prepares the child's constitution for an invasion of tuberculosis. In this
way hospital treatment might exert a salutary effect, and diminish the death-rate. The following
quotation from the memorandum on measles issued by the Local Government Board during the
recent epidemic may be of interest.
"There are numerous cases of measles, the hospital treatment of which will increase the
prospect of recovery. For most cases, however, it appears probable that domestic treatment
will continue to be necessary, and that the greater scope for saving of life lies in more complete
medical attendance, and in skilled nursing and supervision of patients treated at home."
The question of expense is one to be considered as there is no doubt that as hospital treatment
became more universally adopted, as in other zymotic diseases, a large amount of additional accommodation
would be required and that for a considerable part of the time the accommodation would not be
utilised, so that it would also be costly. The whole question of hospital accommodation, however,
is a matter for the Metropolitan Asylums Board.
(6) The existing rules in regard to measles seem sufficient to safeguard the health of school
children, and of the public generally. There has been much criticism of the Council's rules on this
subject, but no convincing arguments have been adduced to demonstrate that the attendance of
children in senior departments, who have already had measles are a source of infection when a case of
the disease occurs at home. It has already been stated that the infection does not cling to fomites or
tend to persist out of the body, and the risk incurred in the conveyance of infection by means of an
intermediary "carrier" is so infinitesimal as to be negligible as far as senior children are concerned,
90 per cent, of whom are probably immune by a previous attack. Further the practice of allowing
protected children to attend school from infected houses is only followed in senior departments and not
in infants' departments. The L.G.B. approve of this principle and it is now being generally adopted
by school medical authorities. The following passage appears in the L.G.B. Memorandum on Measles,
previously referred to :—
"Older children are usually permitted to attend the boys' and girls' departments of schools
from families in which there is at the time a case of measles. There is no evidence that this
practice leads to spread of infection, whether this result be due to the fact that the infective
material is seldom carried in clothes, or to the fact that most of the children in these departments
of schools are already protected."
It may be added that in London, children are only allowed in such circumstances to attend senior
departments if they have already suffered from the disease.
One source of criticism which must be always remembered arises from the Education Authority
having hitherto carried out a uniform plan of treatment of infectious disease among school children
throughout London, whilst locally the regulations and treatment of children out of school varies with
the activity and ideals of the borough sanitary authorities and their officers, so that the regulations
of the Council may be criticised in one district as too drastic, whilst a neighbouring authority considers
these same regulations require tightening up.
Smallpox,
In 1911 there were 70 cases of smallpox received at the M.A.B. hospitals, of these 6/ were from
the Metropolitan area, 12 were cases attending Council schools, and 1 an evening student. Of the
cases 46 were vaccinated, 9 of them being under 20 years of age. There were no deaths among them.
Of the unvaccinated cases, numbering 22, death occurred in 9, 20 were under 20 years of age, with 8
deaths. In 2 cases the vaccination was doubtful and one died. For the whole number of cases the
mortality per cent, of the vaccinated class was 2.2, and of the unvaccinated class 40.9, twenty times as
great. Beginning with two cases of school children in one house in Stepney, notified on February 21st,
two more in the same house were notified on the following day. The cause of the two which were
apparently primary cases infected about February 1st was not ascertained. These four school children
attended three schools whilst probably infectious, but no secondary cases resulted. One child, indeed,
was in school for a week with the rash on her, and was summarily excluded by the medical officer of health
for the district. Eight cases occurred, but none were notified in school children until March 2nd, when
a child previously excluded for measles was notified as having developed the smallpox rash on February
24th. A boy attended an evening school on February 27th in an infectious condition, but no secondary
case occurred.
School investigations were carried out in Poplar, Hackney, and Camberwell. At Tredegarroad
Infant Department a case was reported on March 7th, whose onset was the third or fourth of the
month and the rash appeared on the sixth. On the ninth two other cases were reported from the same
school. The school was at first thought to be a centre of infection, but enquiry showed this not to be
the case. The children all lived in the same street and the mother of two of them had had a mild attack
two or three weeks previously. Three weeks later a fourth case was notified from the same school.
Five other unvaccinated children were in the home, and were all vaccinated at the shelter. No further
cases occurred there. There were 62 children contacts with the various smallpox cases and distributed
over 10 schools to which 60 visits were paid by the medical officers.