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Means for Obtaining Control of Measles.
The question of the administrative control of Measles is a
most difficult and complex one—almost every other year epidemics
of serious magnitude occur with a resulting high mortality. The
control of Measles presupposes a knowledge of its existence, and
this, owing to the absence of a system of compulsory notification,
is, so far as the Sanitary Authority are concerned, a matter
largely of conjecture. The main source of information as to the
occurrence of cases is that obtained from the Schools for the
most part, from data supplied as a result of inquiries into absence
by the School Attendance Officers. While a large number of
cases are in this way brought to the notice of the Medical Officer
of Health, it is probable that these represent only about a third
of the total number of cases actually occurring in the District—
furthermore, the information is often too late for preventive
measures to be of much avail. These are difficulties in the
application of a compulsory system of general notification in this
district. In probably the majority of cases a doctor is not in
attendance, and although under the Public Health Act the duty
of notification is placed on the parents as well as the Doctor,
experience shows in the case of other diseases that this duty
would, if compulsory notification was in force, be more honoured
in the breach than the observance. Owing to the long interval
between the commencement of the illness and the appearance of
the rash, its nature is frequently not realised, and as this is by
far the most infective period, the disease has been conveyed to
others before steps for securing isolation could be undertaken.
Compulsory notification would entail a considerable expenditure
in the provision of notification fees (about £8,000 per annum for
London). At the same time it is quite apparent that the activities
of Local Authorities are greatly impeded by lack of early and
complete information of the occurrence of cases, and unless means
are found to supply this defect, it is to be feared that control of
epidemics of Measles will not be secured.
It has been suggested that immediate notification by the
householder to the School should be required in the case of any
illness of a suspicious nature in any child of School age, and in
the case of children below School age the Medical Officer of
Health might be notified.
Home Isolation and Treatment.
One of the great difficulties in relation to the administrative
control of Measles is the apathy and carelessness displayed by
the public as regards the importance of the disease. In the
majority of cases the Doctor is not called in, at least not in the
early stages of the disease, and frequently little or no attempt is