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(4) The protection of schools and the prevention of epidemics would be
furthered by enabling infected children to be detained at home, and
by affording earlier opportunity to send printed and other instructions
for dealing with the disease and preventing its spread.
(5) Notification would enable isolation in hospital and disinfection of the
dwelling-room and contents to be carried out. This would (a) check
the spread of the disease, (b) tend to reduce the virulence of the
disease by improving the surroundings, and (c) diminish the fatality
by improved treatment, and (d) as measles only lasts half as long as
scarlet fever, twice the number of patients could be treated in the
same number of beds.
B.—The arguments against the notification of measles :—
(1) The maximum mortality of the disease is, during the second year of
age, rapidly diminishing through childhood till it becomes insignificant,
although this may be due to acquired immunity, but the
fatality averages only about 5 per cent, of cases.
(2) The disease is infectious before the characteristic rash appears, and
during the catarrhal stage, or stage of apparent "cold in the head."
(3) It mainly prevails among children before school age, and becomes
more or less epidemic every other year, with extended epidemics
every few years.
(4) In the majority of cases medical advice is not sought; these cases
would therefore not be medically certified, and, if made notifiable by
parents and guardians, ignorance may be pleaded, or medical examination
may have to be enforced to verify the presence or absence of
the disease.
(5) Admitting (a) that isolation and cleansing and disinfection check the
spread, not only of measles, but also of other infectious ailments,.
(b) that improved surroundings reduce the virulence of all infectious
diseases, and (c) that improved treatment reduces the fatality of all
diseases, and that all these are desirable aims; still the difficulties as
to notification are that effective measures of isolation in hospital and
thorough disinfection of dwelling rooms, will require a large amount
of accommodation, and increased apparatus and staff. Assuming
the fatality of measles cases to be 5 per cent., then 20 cases for
every death registered would have to be provided for. The number
of beds would have to be more numerous than for scarlet fever,
because the number of cases of measles is greater; and although
the disease only lasts half as long as scarlet fever, the fatality is less
than half as great. The provision of hospital accommodation, and
disinfection at public expense, would entail a large expenditure,
practically the doubling of the number of beds in the infectious
hospitals, and the doubling of disinfecting staffs and apparatus.
The conclusion drawn was that in large towns the notification of measles is
simply a question of expenditure.