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60
The Question of Notification of Measles. —The County Council's
Order has, by many medical men, been taken to imply that measles is
now notifiable—which it is not.
The responsibility thrown upon the Council, great as that may
be, will be much less than it would have been had the Order made
the disease compulsorily notifiable.
Suggestions to add measles to the notifiable list have been made.
A proposal to this effect was made in 1891 by the late Vestry of
St. Margaret and St. John Westminster, but the Local Government
Hoard declined to make an exception with respect to a single district.
The said Vestry having sought the aid of the other Sanitary
Authorities, I looked into the question, and in the Annual Report for
1891 (pp. 97-106) stated the conclusions at which I had arrived
largely based on the experience of Edinburgh in the years 1880-89,
as set out in a pamphlet by Dr. Harvey Littlejohn.*
When I wrote the report there was no evidence that notification
had lessened the prevalence of the disease, or (isolation being rarely
available) reduced the mortality.
I was and am of opinion that without extensive hospital accommodation
there is little practical utility in notification. But, as
I said in 1891, isolation would be of "the highest value to individual
sufferers by removing them from homes too often wholly unfit for the
treatment of a disease apt, under insanitary conditions, to assume an
unfavourable type, and to kill by complications which might be
averted could the sufferers be placed where they would obtain pure
air and suitable diet, with medical attendance and nursing."
At Edinburgh 30,000 cases were notified in the ten years
1880-1889 (at a cost in fees of £3,500), the maximum number of
notifications (5,833) having been recorded in 1886: 5,220 of them in
21 weeks. The average annual rate of mortality was 3.1 per cent.,
ranging from 5.9 in 1880, when 3,216 cased were notified, to 1.5 in
1881, on 634 cases. Comparison of the dumber of notifications in
two periods of six years —1880-1892—showed no reduction in the
second. In the four years, 1886-89, the admissions to hospital were
at the rate of 5.5 per cent, on the 15,102 notifications. The proportionate
mortality in hospital cases was 4.70 in 1890 and 1.34 in
1891 ; and in home-treated cases 5.06 and 3.22 in the two years
respectively.
* "Ten years of Notification of Measles in Edinburgh."
†In 1888 the late Vestry of Battersea addressed a request to the Asylums
Board that, as measles is "a dangerous infectious disease of a febrile character,"
they should take such steps as they should consider advisable with a view to
arrangements being made for the reception of sufferers therefrom into their
hospitals. The Board replied that they had no legal power to admit cases of
Measles.