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61
With respect to the use made of notification, it appeared that
an inspector called and got the names of the sick children, and the
schools attended by them, saw what means of isolation (if any)
existed, warned the parents about keeping the children at home,
told them what precautions to use, and to send to him when the
house was ready for disinfection, if disinfection were desired.
Endeavours were made to get a first case in a street, in a crowded
quarter of the town, into hospital: but the procedure of removing
first cases could not be systematically carried out. owing chiefly to
want of accommodation; no compulsion was attempted.
It was felt strongly that it was only by dealing firmly with first
cases, removing them, keeping the other children from school and
disinfecting thoroughly, that there was any chance of preventing the
biennial epidemics to which the city had been subject.
As to disinfection, it was only in those cases where the bedding
had been removed that fumigation of the room was done: it was
therefore not done generally, as after scarlet fever, etc.. but always
where specially desired.
The conclusions arrived at by Dr. Harvey Littlejohn (in 1891,
for I have mi later information)* were that "no practical benefit had
(then) resulted from notification so far as the mitigation of the
disease was concerned," and that "in a Large town with a susceptible
population, and hospital accommodation necessarily limited when
compared with the requirements of an outbreak of measles, notification
as a means of checking the disease is practically useless."
It is well to emphasize this point, for not improbably the recent
Order may suggest the issue of one making measles notifiable, to
which I should not object were a reasonable amount of hospital
accommodation provided for suitable cases; for as I wrote in the
report for 1891 (p. 104) :—
"Whatever opinion may be formed as to the policy of making
measles a notifiable disease, there can be no doubt that it would be
wise to make provision to secure the removal of the sufferers to
hospital, compulsorily if necessary, when the home surroundings are
of such a nature as to militate against recovery, seeing there can be
no doubt that with insanitary conditions—want of space, of pure air, of
proper food and nursing—the disease assumes a virulent (suppressed)
type leading to the pulmonary and other complications which are so
commonly the immediate causes of death."
Death from measles is very rare in the families of the well-todo
: in this borough there were no such deaths in 1902. The fatal
cases were with very few exceptions in the families of the labouring
* Since this report was written I have read in the British Medical Journal
that measles is not now notified in Edinburgh.