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42
moreover, in which the poor live in London—two or more
families usually occupying one house, and using a common
staircase—almost preclude the possibility of isolation. But
more care might be taken to protect the sufferers against
secondary affections, of the lungs &c., which are, as a rule,
the immediate causes of death. I entertain no doubt that
many lives might be saved were it practicable to isolate the
little sufferers in hospital, especially such as live in overcrowded
homes, tainted with foul air, and under conditions
which preclude the care so necessary in the nursing and
management of measles. But no provision of hospital
accommodation for cases of this disease has been made.
Should Measles be made Notieiable?—Measles
is not one of the diseases required to be notified to the
Medical Officer of Health under the provisions of the
Public Health (London) Act, 1891; and, as I endeavoured to
show in my report for 1891 (pp. 97—106) it remains to be
proved that any great advantage would accrue from its addition
to the list,unlesshospitals should be provided for the reception
of the sufferers who cannot be properly treated at home, and
these are very many. It is the fact, however, that the disease is
often spread through the agency of schools: it might probably
be held, therefore, that the duration of an epidemic would be
shortened by the closure of schools, which are not seldom
deprived of a large proportion of their pupils by an outbreak.
And, in fact, an epidemic is sometimes, as in 1890, brought to an
end on the occurrence of the long holidays. With a view to
prevent the spread of measles through the agency of public
elementary schools, I addressed a letter, at the commencement
of the epidemic in that year, to the Superintendent of Visitors
of the Chelsea Division, pointing out the desirability of an
effort being m ide to exclude from the schools all children from
houses where the disease exists. The School Board do not allow
children living in infected houses to attend their schools, a
fact probably unknown to many parents. I suggested,