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from the malady; an occurrence which I thought then, and think still, must have been inadvertent
or due to ignorancc. The replies of the then existing sanitary authorities having
shown a considerable divergence of opinion, the Public Health Committee thought it ''desirable
to consult the Councils of the metropolitan boroughs with reference to the proposal," with a
view to ascertain whether they were in favour of the extension to measles of the provisions contained
in any or all of the sections above mentioned ? it being expressly observed that " these
sections do not relate to the question of ' notification,' which is dealt with in sections 55 and 56."
This reservation notwithstanding, it seems to me that the suggestion emanating from the School
Board in 1898, and the communications addressed by the Public Health Committee to the local
sanitary authorities in that year, and again recently, almost inevitably involve the question—
Whether notification of measles is advisable ? for without information as to the existence of the
disease it is not possible to take steps to prevent its spread. This question of notification of
measles was fully considered by the Sanitary Committee of the late vestry, upon whose recommendation
the Vestry, on two occasions, in 1891 and 1898, decided adversely to the principle.
In 1898, moreover, the Vestry approved and forwarded to the County Council a report I submitted
on the subject, as follows: —
" I do not doubt that it would be useful to bring measles within the meaning of the
expression, 'dangerous infectious disease,' so far as relates to exposure, and to the prohibition
of the use of public vehicles for the conveyance of infected persons (Section 70);
but I see no reason to modify the views adverse to the notification of measles expressed in
these reports,* and approved, on more than one occasion, by your Vestry. Probably
not a moiety of the cases of measles in any epidemic come to the knowledge of medical
practitioners. Unless the child is obviously very ill; i.e., unless some of the complications
occur to which the fatal issue in measles is usually due, the illness is allowed,
very generally, to run its course without medical treatment, properly so-called, and
therefore the great bulk of cases would probably escape notification. It is true that
the Act requires a ' dangerous infectious disease' to be reported by the head of the
family; but notification otherwise than by the medical man is of the rarest, and it
would be difficult to enforce. Measles becomes epidemic about every second or third
year. It rages for a few weeks; the sufferers are counted by thousands in a place like
London; and then, for a time, only sporadic cases occur, the fatality being trifling.
But during epidemic prevalence measles is truly a ' dangerous infectious disease,'
and, taking one year with another, is the cause of greater mortality than scarlet fever
or diphtheria.† In this Parish, in 1897, there were only 33 deaths from measles, whilst
in 1896 there were 173 deaths, of which 160 were registered in 24 weeks, including 45
in one period of four weeks. Having regard to the low percentage mortality of measles,
this number of deaths (160) indicates an immense number of cases, probably not less
than 6,000, as compared with 1,780 cases of all the notifiable diseases recorded in that
year.‡ To deal with such a mass of cases (if they did get notified) in so short a period
as half a year—and without action mere notification is useless—would be a task of
great difficulty. And what could we do? I have always held to the view that,
without hospital accommodation for the bad cases which occur in the crowded and
unhealthy homes of the poor, where, owing to complications induced by insanitary conditions,
the disease so often proves fatal, no substantial benefit would accrue from
notification. There is no such accommodation, nor is there likely to be, and therefore
notification would be of little avail as a means for reducing the fatality of measles.
The disease is exceedingly infectious, and once in a tenemented house, or a house let
in lodgings, swarming with children, it is almost impossible to prevent it from spreading
to all who are susceptible to the infection. The School Board do not allow of the
attendance at school of children from infected houses, and if measles were made notifiable,
the head teachers would have some increased facilities for excluding children from infected
houses. But this end might be equally well attained by the adoption of a course I
suggested some years ago; viz., that when measles (or, for the matter of that, any
other infectious disease) threatens to become epidemic, parents should be informed
that school attendance is not allowed in the case of children living in an infected house.
I venture to think that this course should be adopted and proved to be ineffective
before resorting to notification, which would certainly be costly, and involve much labour
and trouble, probably to little purpose."
I have since the publication of the above report seen no reason to alter my views on the
subject, but I may add that it would be well if hospital accommodation on a moderate scale
could be provided for measles, so as to permit of the removal of sufferers living in insanitary
houses, where, too often, a fatal termination to the illness is due to unhealthy surroundings.
Death from measles is a rare occurrence in the healthy homes of well-to-do people; and when it
happens amongst the poor it is often the result of the ignorance of mothers, who, regarding the
disease as inevitable and not very serious, omit too generally to obtain medical assistance till it
is too late to be of any avail.
* The question of the notification of measles was fully dealt with in the Annual Report for 1891 (pp. 97-106 inclusive),
in which it was shown that no benefit had accrued therefrom at Edinburgh ; 30,000 cases of measles having been notified
(at a cost of £3,000), in the ten years 1880-89.
† The corrected annual average number of deaths in London from measles, in the ten years 1890-99, was 2,822 ; from
scarlet fever, 915; from diphtheria, 2,478. In 1900 the deaths from the several diseases were 1,936, 361, and 1,609
respectively.
‡ In 1900 the notifications were only 986, including 765 from small-pox, scarlet fever, diphtheria and enteric fever;
the disinfection cases. Of measles there were probably between 3,000 and 4,000 cases.