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MEASLES.
29
(a) the fact that there is no provision for informing the local authority of the ocurrence of
a case of the disease ; and (b) the habit which so many parents have of treating cases
of measles without calling in medical advice. It is hoped, however, that two useful results
will accrue—(i) that parents will come to regard measles as a serious disease, which it is if
not properly treated, and will take more care to prevent the spread of infection; and (ii)—
consequentially in part from (/)—that the children will have a better chance of escaping
infection at the younger ages,
If the Order is to be of real effect it will be mainly through the co-operation of the school
teachers. The following extract from Miss O'Kell's report is of interest in this connection :—
" It has been interesting to watch the effects of the Order made by the London County Council (April 1903/
applying to Measles, the sections of the Public Health (London) Act of 1891 relating to disinfection and
the spread of infection. Undoubtedly one of the chief effects has been to raise (in the opinion of the
public) the importance of the disease.
Immediately before the Order came into operation the teachers of all elementary schools in the District
were visited, and their co-operation asked for in making the Order as effectual as possible by regular and
prompt notification of cases; and though I cannot say that all Schools have responded equally to this
request, it must be recorded that many have aided us to the best of their ability, and, as they frequently
admit, to their own advantage.
There are many practical difficulties which the teachers have to contend with and which some teachers
make notable efforts to overcome. The chief is their difficulty in quickly learning of the existence
of cases. The School Board Visitor reports too late to be of use, and many teachers decline—and are
surely justified in so doing—to send a message by a scholar to a house where infection is suspected.
Continued absence of a child suffering from measles is not infrequently reported by a brother or sister as
a "cold " or " bronchitis." This is known to be done in order to avoid the temporary exclusion from
school of the whole family, which is often keenly resented by both parents and children, because of the
custom of the Board in awarding medals for regular attendance. It would seem only fair to credit
children with these enforced absences, but the Board take a different view of the matter, and will only
reward for actual attendances made ; hence a certain amount of deception is practised."
As regards prevention of spread of infection, it may be explained that owing to the
specially insidious onset of the disease, the patient being then highly infectious, it is regarded
by the Department as almost impossible to prevent secondary cases in households containing a
number of susceptible children. The efforts of the Department are therefore directed to prevent
the spread of infection to other households—in other words, the family rather than the patient
is dealt with for isolation. Given early information of the first cases occurring after a lull
in the prevalence of the disease, it is believed that the disease can with the co-operation of
the public be prevented from becoming epidemic.
The mortality last year was at the rate of 0'26 per 1,000 persons of all ages, being O'lO
below the mean rates. The mortalitv in 1902 was 0'55. The mortalities in the SubDistricts
are compared with the various mean rates below :—
Borough
St. Mary
St. John
North-West Paddington
1903
0.20
0.35
0.02
0.23
Measles.
Death.rates.
Five years.
1893.97
0.36
0.45
011
0.39
Mean Rates.
Five years.
1898.1902
0.36
0.45
0.10
0.39
Ten years.
1893.1902
0.36
0.45
0.10
0.39
Of the rates included in Table 15, that of Paddington (0.27) was exceeded by those of
Marylebone (0.28) and Willesden (0.66), while of those for last year, included in Table 16,
all were higher than the local rate except that (0.17) for " Rest of England and Wales'
(Rural Districts).