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" I should therefore advise the Committee under article 88 of the Education Code,
to exclude children suffering from measles for a period of one month, and "contacts"
for three weeks, and then only to readmit them after the rooms, etc., have been
disinfected.
" The reason I have chosen this period is that in the majority of measles
disinfection could take place at the end of three weeks, immediately after which the
" contacts " would return, the patient remaining away for another week. In addition
these three weeks would cover the incubation period, when those " contacts " who had
not previously had measles would have an opportunity of contracting the disease.
" Arrangements have been made to inform the head master of the school by postcard
immediately disinfection has taken place in any particular case, so that unnecessary
delay may be avoided."
As the epidemic seemed to proceed unchecked, and my recommendations were not being
strictly carried out, I made a Special Report to the Committee pointing out the difficulties of our
position and suggesting, if we were to continue disinfection, etc., that we should have compulsory
notification so as to have a legal basis on which to act.
As I did not specifically recommend notification, the report was simply sent on to the
Council and nothing particular was done.
The following is a copy of the Special Report:—
" September 13th, 1904.
" Gentlemen,—The necessity of making some effort to control measles being
now admitted by all those interested in sanitary matters, it is unnecessary to refer
to this part of the subject further than to state that the average death rate for
this disease for the ten years ending 1902 was "79 per 1,000, which is the highest
rate for any single zymotic disease, diarrhoea excepted, which was '86. The usual
preventive measures, viz., notification, isolation, disinfection, school closure, and the
application of those sections of the Public Health Acts dealing with disease prevention
have all been tried with varying success.
It is the object of the present report to show the anomalous position in which
the recent Order of the London County Council has placed us by applying those
sections of the Public Health (London) Act, 1891, which ostensibly give us powers to
deal with measles, but which we cannot effectively enforce. It is similar to supplying
an army with guns, powder, etc., but leaving out the means of igniting the latter.
The two sections which the London County Council left out are notification and
removal to hospital.
" Taking removal to hospital first, I do not think it is advisable or practicable to
provide hospital accommodation for measles. The disease is very widespread and
comes in epidemics, which would strain whatever hospital accommodation we could
provide to the utmost. Practically all deaths in this disease are due to complications
and occur in the first five years of life. Out of 90 deaths which occurred during the
first six months of the present year in Bermondsey, 86 were of children under five
years.
" There is no doubt that many of the deaths are due to ignorance and carelessness
on the part of the parents, and anything which teaches the parents to look upon
the disease as a serious one will do a great deal of good.
" We have just passed through a rather severe epidemic in Bermondsey, and
the experience gained by it has emphasised the difficulties of our present position.
"In dealing with any infectious disease the first thing is to know where it is.
Granted this, the three essentials of the information are that it must be (1) early,
(2) accurate, and (3) complete. Practically the only information we receive at
present of the existence of measles is from the school notifications, and our recent
experience shows that these notifications are wanting in the essentials just mentioned.
"In the first place these notifications are not early. The information in them is
very rarely less than a week old, and not infrequently is four weeks old. This
arises as a natural consequence of the way the information is obtained. A child is
absent, and as soon as the teacher can find out the cause of the absence, either
through brothers or sisters of the absentee, neighbours' children, or, on the return
to school of the child, she reports to the Medical Officer of Health. The longest
delay is generally when the cause of the absence is ascertained from the patient on
his or her return. These absentees are at the same time reported to the school
visitor about twice a week, or as often as he may call at the school.
"In the second place the information is not accurate. Between February 28th
and July 2nd (18 weeks), which practically covers the epidemic period of measles
referred to above, 687 cases were reported from the schools. In 55 the addresses
were wrong, in 142 the disease was not measles but some totally different complaint
or some other excuse for absence, such as want of boots, etc. Thus nearly 200 or
about 29 per cent, of the notifications were incorrect, necessitating a very large
amount of unnecessary work on the part of your Inspectors.
" In the case St. Paul's School most of the eases were discovered by the enquiries
of the Inspector and not through the school notifications.
" In Grange Walk School I only learned of the existence of an epidemic by the
head teacher sending to me for a certificate for the epidemic grant which she was
unaware had been abolished. On visiting this school the number of notifications I got
one morning were 57, of these 36 turned out to be genuine cases, in 18 there were no
measles in the house, and in three wrong addresses had been given.
"In the third case the information is not complete. Many cases occur which are
never heard of unless someone in the house happens to attend a school, and all our
information practically ceases during school vacation.