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49
disease have occurred in the Borough as elsewhere—with characteristic
regularity, usually every second year. During the first 15
years of this period notification was not compulsory and we relied
for our knowledge of the prevalence of the disease mainly upon the
reports from the public Elementary Schools. During this period
the average annual death-rate from Measles was 51.63 per 100,000
of the population. In 1916, Regulations were made under the
Public Health Act making the disease compulsorily notifiable.
The Regulations were rescinded at the end of 1919. During this
period the average annual mortality was 28.87 as compared with
53.35 in the preceding quinquennium, a reduction of 44 per cent.
It is reasonable to infer therefore, that the introduction of
compulsory notification was responsible to some extent at least,
for the decline in the death-rate from this formidable infectious
disease of child life, which accounts for more deaths, especially
amongst the age group under 5 years, than all the other common
infections.
The main reason given for the rescinding of the Regulations in
1919 was that notification per se was in the special clinical circumstances
associated with Measles, useless, and that only where notification
was combined with a definite co-ordinated scheme for
promptly dealing with outbreaks was the expenditure involved
justifiable. The Ministry were, however, prepared to make an
order making the disease notifiable by Regulations made by the
Minister of Health in the district of a local authority prepared to
carry out an approved scheme for dealing with Measles.
The Council took advantage of this attitude of the Ministry,
and in 1922 the disease was made compulsorily notifiable in the
Borough.
The effect of this decision of the Council would appear from the
statistical evidence relating to Measles in Battersea during the
period 1922-1926, to have been fully justified, and while there
has been no diminution in incidence in epidemic years, there
undoubtedly has been a decline in mortality. For example the
average annual mortality which had decreased during the period
1916-1919 to 28.87 per 100,000 from 53.35 as compared with
the previous 5 years, had still further fallen in the 4 years 1922 to
1926 to 22.04 per 100,000.
It is probable, however, that decreasing virulence, which, in
recent years, has been a feature in this, as in the case of other
diseases, e.g., Scarlet Fever, has been a factor in the reduction of
the death-rate. There can, I think, be no doubt that notification,
combined with the other precautionary measures which have been
taken in Battersea, has contributed to this satisfactory result, and
that, as a system of notification is a necessary preliminary to active
measures for limiting the disastrous effects of outbreaks on the
child population, such action has been fully justified,