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33
patient makes a good recovery, that it is believed that the handbills
were of value in preventing the Parish from swelling the thousands
of preventable deaths from Measles which are registered in London
alone, each year.
Whereas I acknowledge with gratitude the willing assistance
rendered me by the head teachers of the Board and other Schools in
ascertaining the number and addresses of the absentees from Measles
and Whooping Cougb, I consider it a matter for regret that the
Regulation of the School Board for London, requiring that the
Medical Officer of Health of the District shall be informed of a
child's exclusion on account of symptoms of infectious disease, is not
given effect to as a routine practice, for it would often materially
assist the Medical Officer of Health in taking prompt measures to
remove further risks of school infection.
It may be useful to bring Measles under the Notification Act in
rural districts and in small isolated communities, if in these cases
even advantage is taken of the information thus obtained, if efforts
also be made to detect unnotified cases, and the means of hospital
isolation be provided; but in larger communities, especially when
not adopted in neighbouring districts, the measure is not to be
recommended in the absence of sufficient isolation provision, a large
permanent staff, and the adoption of other means than "notification"
of bringing the existence of cases to the knowledge of the sanitary
authority. In short, if it were possible, in urban districts, to deal
with every case notified with the same care and thoroughness as in a
case of Small-pox, it would prove of value.
The effect which the greater care exercised by the better-class
inhabitants in guarding against exposure has upon the mortality from
Measles among that class, is shown by the circumstance that the
mortality during epidemics is always very largely borne, and sometimes
wholly, by the poor.
What we have, then, to face is a largely preventable mortality
due to ignorance, a mortality which is very high among the poor, and
very low among the better classes. Surely the best remedy lies not