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89
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 usually
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, when 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 decrease in the incidence of Measles occurred in 1933. The following
tables and graph give the details. There were 437 notified cases. St. Pancras is one of the
few Local Authorities which have made Measles and German Measles notifiable. Because of
these measures and the routine "following up" we are able to maintain a strict supervision
over the great majority of cases in the Borough.
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 42. 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 486 cases
during the year 1933, as compared with 65 cases during 1932. There were no deaths. This
is the largest epidemic which has been recorded for many years. It was a very mild illness
with a rapid recovery.