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32 measles.
Since 1903 systematic efforts have been made to check the spread of measles, and the
statistics given above appear to justify the belief that those efforts have not been entirely
unsuccessful. Three years constitute too short a period for definite conclusions, and,
moreover, in 1903 and 190-1 the system was undoubtedly not working as efficiently as it is at
present. Most of the cases are reported by the school teachers, and, although there has been
a very great improvement in the promptitude of reporting, certain teachers are still slow in
sending the information. It is not uncommon to hear of attacks, not through teachers of the
schools attended bv the patients, but through teachers of other schools to which other
families in the house send children. For this there is some excuse, as many parents report
"cold" or other indefinite complaint to the school, while recognising, and confessing to the
other residents in the house, the true nature of the illness. The efforts of the Department are
very seriously handicapped if cases, and especially the first cases, are not reported at the very
earliest possible date. It is better to report a suspicion than to wait for a certainty.
One verv serious defect in the present system is the want of co-operation on the part of
the Sunday Schools. A few of those schools seek for information from the Department and
exclude children from infected houses, but none send any information.
As the Department depends on the schools for information, cases occurring during the
holidays largely escape supervision. How this defect is to be remedied, except by the introduction
of compulsory notification, it is impossible at present to say.
t
Since the issue of the Order made by the County Council in 1903, disinfection has been
regularly carried out after cases of measles. The total number of such disinfections last year
was 1,078. Some scepticism exists as to the need or utility of disinfection. One objection—
perhaps the most usual—is that several disinfections will be required in the same family.
Last year disinfection after this disease was carried out twice for 36 families, and three times
for one. It may be useful to give some particulars:—
36 families 2 disinfections.
In 8, the second attack appears to have had an independent origin, as may be judged
from the intervals
April—October (a) | April—June | April—July | March—May | March—November (a)
April—May—June (b) | February—April | January—April (a)
(а) The second cases here were reported to be second attacks in the original patient.
(b) The sequence of events in this family was as follows:—
N.B., sickened 8 iv.; A. B., sickened 15 iv. Disinfection 22 iv.
N.B., „ 23 v. ; A. B., „ 3 vi. „ 30 vi.
In 11, there was a second child ill when the first disinfection was carried out, the nature
of the illness not being disclosed until a later date.
In 17,.secondary cases occurred at the following intervals :—
0 day, 1 3 days, 2 7 days, 1
1 „ 6 4 „ 2 14 „ 1
2 days, 1 5 „ 2 21 „ 1
At least 15 of these patients were infected before disinfection was performed, leaving 2
as possible failures, i.e., cases where the disinfection did not prevent the recurrence of
secondary infection.