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disinfection of infected rooms, things, persons, or conveyances; and, also, to
effectually isolate the infected house and its inmates as nearly as possible as
if it were a temporary infectious hospital.
The most essential question to settle first is the proper form of disinfection
after measles, and whether it is beyond the compass of the person in charge
of the patient, and others, or whether it requires the appliances and skilled
servants of the Sanitary Authority to perform.
If an attempt is to be made to stem the spread of measles without providing
hospital accommodation, the infected dwelling-house must be treated
as a temporary infectious hospital, and be cleansed and disinfected thoroughly
before it can be considered free. The process of disinfection should not be
one whit less thorough than in the case of scarlet fever, namely: the
steaming of infected bedding and clothing, and the fumigation, stripping,
and cleansing of infected rooms and places. In all but a few cases this can
only be done properly by the skilled servants of the Authority. The first
point, therefore, to decide, is whether the Borough Council will incur the
additional expense, which practically means increasing the expenditure upon
disinfection from a half to as much again.
A decision to disinfect at public expense after measles, at once raises the
question whether it would not be better to make measles a notifiable disease
straight away rather than to adopt half measures. Unless made entirely
notifiable only the cases attending school will become known to the Authority,
and a number of unknown cases will continue to spread the disease, children
under compulsory-school age (5 years) being most liable to it and under
voluntary school age (3 years) most especially so. In this way cleansing and
disinfection may be brought into disrepute, the half-measures may probably fail,
and a wrong conclusion be drawn. Without hospital provision for isolation the
effect of notification must, of necessity, be incomplete in preventing disease,
and it would be necessary to bear this in mind and to remember that scarlet
lever and measles would not be comparable notifiable diseases in this respect.
During 1895, the question of the notification of measles was raised in
several directions, and on the 22nd January, 1896, the late Vestry of St.
Pancras considered a report from me on the subject. The essential points of
that report were as follows :—
A.—The arguments in favour of the notification of measles :—
(1) Measles causes a larger number of deaths than any other infectious
disease, excepting whooping-cough and diarrhœa.
(2) It is highly infectious, and the infectiousness continues after the
appearance of the rash and until the branny peeling ceases.
(3) It is largely spread through the medium of schools, and it is too late
to close schools after the disease has obtained the hold shown by the
death returns.