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Other Notifiable Diseases.—With the exception of tuberculosis, which is dealt with in a
separate section, no notifiable infectious diseases, other than those to which reference has been
made, were notified during the year.
Non-Notifiable Diseases.
Measles.—Epidemics of measles occur about every two years in London. During interepidemic
periods the disease is quiescent and any preventive or ameliorative measures which
may be required can be carried out through the usual procedure consequent upon voluntary or
compulsory notification, as the case may be, without resort to concerted action. In such periods
of low prevalence the mortality from measles is low, but when widespread epidemics appear the
high death-rate among young children due to the complications of measles and the amount of
physical disability due to the after-effects of the disease render it imperative that every possible
resource of the public health and educational authorities should be utilised in controlling the
disease. In 1926, representatives of the Ministry of Health, the London County Council, the
Metropolitan Branch of the Society of Medical Officers of Health and the Metropolitan Asylums
Board met and as an outcome of their deliberations, the following scheme for the reception of
•cases of scarlet fever and measles into the Board's hospitals was recommended :—
(a) That the Board should allocate from time to time a number of beds for measles
and a number for scarlet fever, such allocation to be altered by the Board as circumstances
demand.
(b) That cases of scarlet fever and measles be admitted on doctor's certificates as now,
without reference to the medical officer of health.
(c) That when shortage of beds for scarlet fever or measles is imminent the Board should
inform the medical officers of health and accept cases only upon their recommendation.
(d) That during such shortage of beds applications for admission from general practitioners
should be referred to the medical officers of health for recommendation.
(e) That the selection of cases for admission should be based on type of home rather than
type of case.
( /) That cases of measles in tenement houses where there are no facilities for home nursing
or in houses connected with shops or where a member of the family is employed
in the handling of food, should be given priority over cases of scarlet fever in single
family houses where isolation is possible.
The Metropolitan Asylums Board adopted the scheme and in 1927 the approval of the
Ministry of Health was obtained.
With the object of reducing the mortality and mitigating the complications associated with
measles epidemics by the prompt removal of cases to hospital the London County Council, in
conjunction with the several metropolitan borough councils, have drawn up the following scheme
to operate during epidemic periods.
Action by the School Medical Service.—The school medical officer will inform the divisional
medical officers daily of the schools in which the scheme should be put into operation and the
divisional medical officer will instruct the school nurses to visit such schools daily with a view
to carrying out the following procedure :—
(1) The school nurse will obtain from the head teachers of infants' departments the
names and addresses of all absentees in affected classes and of absentees under 5 years of
age, where the cause of absence is due to suspicious illness or to unknown causes, and (a)
will enter the particulars on special slips to be provided by the divisional officer (education
department). If the divisional office is within reasonable distance the nurse will deliver
these slips in person to the divisional officer on the day of her visit, but otherwise she will
despatch them at once in an envelope marked " urgent " or (b), in boroughs where special
agreement has been reached, involving the appointment of special officers to deal with measles,
instead of informing the divisional officer, the school nurse will furnish the names and
addresses directly to the health visiting officer of the borough council.
(2) The nurse will make special enquiry as to children up to and including 5 years of
age, and as to children in any classes in which cases of measles have occurred, with a view
to detecting any children who may have come to school with possible early symptoms of
measles.
(3) Children discovered in school to present signs indicating the possible onset of measles,
such as coryza or with definite symptoms of measles, must be sent home at once in charge
of an elder brother or sister or some other responsible person. The borough medical officer
will be informed at once and the head teacher will be askea to send particulars of such cases
immediately to the three officers concerned.