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" From these considerations it would appear that if these sections continue to be
applied to measles by the London County Council, and if they wish the sanitary
authorities to enforce them, it follows as a logical consequence that cases ought to be
notified in the same way as any other infectious disease. Proceedings can always be
taken on a notification certificate, and in fact it is the only basis for proceedings in the
notifiable diseases. In many cases we have had refusals to disinfect and great difficulty
has not infrequently been experienced in enforcing it. The result in many cases has
been arrived at by a compromise on our part.
" There are difficulties of course attending the notification of measles, one being
that it has apparently done no good in some of the districts where it has been tried.
This is probably due to its not having been tried for a sufficiently long period, or to
imperfections of diagnosis. It is generally stated in measles that the mischief is done
before the rash appears, but I cannot think that this will prove an insurmountable
difficulty in the future, because with a little patience it is now possible to diagnose
measles a day or two before the rash appears, and when bacteriology comes to our aid,
as no doubt it will, we shall have full means of early diagnosis.
" Another difficulty is that a great many medical men do not at present draw a
sharp distinction between ' epidemic roseola,' often known as German measles, and
ordinary measles. German measles is a comparatively trivial affection, and is rarely a
cause of death, either alone or through complication. If it was pointed out, however,
that it would not be notifiable, but that notification would be strictly confined to
measles, I have no doubt that in time this difficulty would be done away with. If the
principle of notification were adopted, the matter of the amount of the fee and other
details could be settled later, but the present requisite is a medical certificate on which
action can be taken.
" There are other points which might be mentioned in dealing with measles
epidemics. Since the disease, as shown above, is most fatal under five years, if infant
classes were done away with, and the children not sent to school during this period,
there is no doubt that measles epidemics would be greatly curtailed, and those which
did occur would be postponed to a later age period. The abolition of these would also
save about 14 per cent, of the present school rate, so that it would have both hygienic
and economic advantages.
" Another practical and useful check to measles would be the printing and
distribution of a leaflet giving general instructions on the importance of careful
nursing, etc., in cases of that disease. I should be glad if the Committee would give
me instructions to have such a leaflet drawn up and printed.
" Your obedient Servant,
" R.K. Brown,
" Medical Officer of Health."
The annexed table gives the number of notifications received from the schools, the
number of " contacts" included and the number of deaths in fortnightly intervals.
Patients.
Fortnight ending
" Contacts."
Deaths.
January 16th
12
17
-
January 30th
14
11
3
February 13th
6
14
4
February 27th
34
64
2
March 12th
23
19
4
March 26th
96
4
48
April 9th
38
37
10
April 23rd
64
155
10
May 7th
81
148
11
May 21st
142
172
19
June 4th
177
159
6
June 18th
57
125
9
July 2nd
8
57
129
July 16th
16
63
4
July 30th
5
10
54
August 13th
Schools closed
-
August 27th
25
38
3
September 10th
19
24
2
September 24th
37
110
-
68
October 8th
24
1
October 22nd
58
92
5
74
November 5th
23
6
November 19th
20
35
6
79
December 3rd
4
49
57
December 17th
42
5
December 31st
8
7
5
1089
1842
136
The figures in the first column do not give an idea of the number of cases which occurred
in the Borough, probably not more than half, or at most two-thirds, of the cases which occur
come to our knowledge.
The number of rooms disinfected were 917, in addition to portions of 9 schools which
were closed on account of measles.