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83
The tendency for the disease to be prevalent in alternate years is very evident,
especially when followed graphically. The third and fourth quarters of the year are always
comparatively free, but frequently a rise commences in December and is continued in the first,
and generally, but to a less extent, in the second quarter. The wave in December is frequently
seen just prior to an "epidemic year." The value of this knowledge is obvious. On the
warning signs of a rise, the machinery to combat an epidemic is put to work in a more
particular manner. Leaflets explaining the diagnosis, prevention and treatment of the disease
are distributed through all schools, welfare centres, and similar institutions. Much of the
time and energy of the staff is especially diverted to combat the spread, and the facilities for
nursing the cases at home are increased. In 1927 the Fever Hospitals adopted the practice of
admitting cases of Measles. Previously Scarlet Fever had the preference, almost to the
complete exclusion of Measles. During epidemic times, wrhen there is a heavy demand for
beds, cases of Scarlet Fever are only admitted on the recommendation of the Medical Officer
of Health.
Measles is considered to be a more serious disease now than Scarlet Fever. It has a
higher Mortality Rate, and its complications are more numerous and often very serious
and crippling.
The Mortality Rate swings irregularly, but with a tendency to follow the curve of
incidence and not coincide with it.
In the 1928 Annual Report an investigation was made into the result of treatment at
home and in institutions, and the mortality of cases treated at home was shown to be
markedly less than that for cases removed either to Highgate or one of the Fever Hospitals.
There are many factors to consider in this brief statement, but it is evident that, unless home
conditions are bad, treatment is better there. Therefore, during epidemics cases are selected
for institutional treatment rather on account of home conditions than the gravity of the
attack of illness.
An analysis of the age distribution demonstrates that Measles is most common between
one and five years. It is not frequent in infancy and comparatively uncommon in adult life.
In epidemic years the mortality rate is very high in infancy.
The expected fall in incidence occurred. Only 430 cases and two deaths were notified in
1931. The Borough, therefore, experienced the lowest recorded Mortality Rate, 4.7, with
the one exception of 2.4 in 1925. Expressed in other terms these deaths from Measles were
in 1931 equivalent to an Annual Death Rate of 0 01 in St. Pancras. This compares very
favourably with 0.08 for the whole of England and Wales, or 0.1 for 107 of the County
Boroughs and great Towns, or 0.07 for a group of 159 smaller Towns, or even the 0.03 for
London. St. Pancras is one of the very few Local Authorities which have made Measles a
Notifiable Disease, and in that way maintained a strict supervision over the great majority of
cases. This probably accounts for these highly satisfactory results.
Every case which comes to the notice of this Department in the various ways indicated
above, or through the School Authorities, is visited by a Health Visitor. Her visit has a
double value. It gives her an introduction into many new families and enables her to
spread the teaching of the rules of good health. She also is able to give the mother advice
and help as regards the patient. Where actual nursing seems necessary for the case, this is
arranged for by the Health Visitor and carried out by the staffs of the several nursing
associations. Details of how this work is done under a Block Grant from the Borough
Council is reported on page 43. Where a medical practitioner is in attendance a card is left
for him, suggesting that, if he agrees that the circumstances show the desirability of a visiting
nurse, this will be carried out under his instructions on receipt of the card duly signed. It
is surprising how frequently doctors omit to take advantage of this very useful service.
German Measles is not common, and generally is a mild disease. There were 68 eases
during the year 1931, as compared with 116 cases during 1930. There were no deaths.