View report page

91
Ministry of Health measles and German measles were made compulsorily notifiable in the following
metropolitan boroughs as from the dates mentioned in brackets—Lambeth, St. Pancras, Paddington
and Fulham (1-4-20), Greenwich (1-7-20). In St. Pancras and Lambeth notification by the medical
practitioner is limited to the first case in the household.
On the instructions of the Public Health Committee the County Medical Officer presented in
December, 1920, reports as to measles in London, with recommendations as to measures which in his
opinion would be of advantage for the better control of the disease, and as to the compulsory notification
of measles.
In these reports I described the methods which had been employed by the Council during many
years past for obtaining information of cases and securing control of the disease through the medium of
the school organisation. It was explained that special methods are adopted where there are indications
of rising prevalence, with a view to speeding up the machinery of " notification." The scheme of
co-operation between the nurses, attendance officers, and the staffs of the local sanitary authorities
was also referred to. As was pointed out in the annual report for 1919, this last-named scheme was
devised, as the outcome of the rescission by the Ministry of Health of the Compulsory Notification
Order of 1915, with a view to securing more efficient co-operation of the various services concerned in
efforts to combat measles. It was suggested further, that it should be incumbent upon the parents
to notify the head teacher within 48 hours when a child is kept at home on account of illness, stating
the apparent nature of the indisposition from which the child is suffering.
With regard to the question of compulsory notification, it was pointed out that this was in force
throughout the country during the years 1916-1919, inclusive, and that the original Order of the late
Local Government Board had been revoked by the Ministry of Health on the ground that compulsory
notification as a general measure was not the best method of dealing with the problem of measles.
Compulsory notification had thus been given a trial extending over a period of four years. The following
reasons were, moreover, given in the report showing that the balance of advantages as between the compulsory
and voluntary systems could not be said to be in favour of the former.
(1) In a large proportion of the cases a medical man is not called in at any stage of the disease,
and in another large proportion only when serious complications have set in and death is imminent
is medical advice sought. It is principally in the class of home in which a medical man is not called
in that early information is most desirable.
(2) Compulsory notification is costly to the community, and on that ground should not be
adopted unless there is very strong evidence that it is necessary or will be instrumental in reducing
mortality. It is estimated that on an average it would cost the community between £6,000 and £7,000
annually, even if the notification were limited to the first case in the household. If every case were
notified, the expenditure would be correspondingly increased (probably nearly threefold). It is
claimed that an expenditure thus entailed could be utilised more beneficially in extending and rendering
more efficient schemes of home nursing.
(3) Compulsory notification has often been tried in various towns and localities, and has been
as often abandoned because the advantages gained were by no means commensurate with the expenditure
involved.
(4) Experience shows that more complete information may be obtained through the school
organisation, especially if the machinery is speeded up and rendered more efficient.
An analysis of the results accruing from compulsory as compared with voluntary notification in
one of the London boroughs, where compulsory notification was in force was made for a period of
three months in 1914. It was found that during the period in question 95 houses were invaded by measles.
Of these, 87 per cent. contained school children, and 78 per cent. were reported through the school
organisation. The comparatively small leakage of 9 per cent. could no doubt be further reduced. Of
the 13 per cent. of houses in which knowledge could not have been received from the schools, 6 per cent.
were houses in which there were no children of school age, 4 per cent. were above the elementary school
class, and in 3 per cent. no information could be obtained. Of the whole 95 houses invaded, only 66 per
cent. were made known through compulsory notification as against 78 per cent. through the schools.
It has been urged that the information received through the school organisation is not sufficiently
expeditious, but the means exist, and in fact are being utilised, for accelerating the machinery of
voluntary notification. Every borough council, moreover, has power, with the sanction, and under the
regulations, of the Ministry of Health, to introduce an order for compulsory notification, and a certain
number of such orders have already been made by borough councils, as has been previously stated.
Thus local option is preserved.
It is now recognised that the main desideratum in dealing with measles is an efficient scheme
of home nursing, and it is in this direction that the efforts of public health authorities should be mainly
directed.
Arising out of these reports the Public Health Committee invited representatives of the Metropolitan
Borough councils to confer with the Council's representatives on the recommendations submitted
by the County Medical Officer. At the conference held at the County Hall, Spring Gardens,
S.W., on 25th February, 1921, the above-mentioned recommendations were carried by the delegates
present and in addition a resolution was passed with regard to compulsory notification.
These resolutions are at present sub-judice and a pronouncement of the Council's policy will
in due course be made.
Whooping
cough.
The number of cases of whooping cough occurring among school children during 1920, was 8,779, as
compared with 3,397, 11,671, 7,117, 8,595, 10,959, 9,977 and 9,762 in the years 1919, 1918, 1917, 1916,
1915, 1914 and 1913 respectively. Whooping cough is notifiable in the boroughs of Holborn, Wandsworth
and Greenwich.
61004 N 2