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I. The mortality from measles amongst children being greater than the mortality from
all the notifiable infectious diseases put together.
II. The want the Board experienced of precise and accurate information of the prevalence
of measles in the homes of those attending the schools, and the consequent difficulty of
systematically excluding children coming from infected houses.
III. The risk of the closure of schools from the alleged prevalence of measles in a district
without adequate justification, the medical officer of health having no definite information of
the extent of measles in the district.
The Public Health and Housing Committee felt that further information as to the usefulness of
the notification of measles was desirable before any decision was arrived at, and consequently addressed
a letter to the Local Government Board, asking what is the experience of the Board as to the value of
compulsory notification of measles in enabling sanitary authorities to obtain control of that disease in
urban communities.
In reply the Local Government Board stated that the Board were then engaged in an inquiry as
to the measures by which the spread of measles can be checked, but that they anticipated that this inquiry
would not be completed for some time. They were not then prepared to express a definite opinion on
the questions which the Council had addressed to them.
Letters were also addressed to the several sanitary authorities in London, asking what had been
the action of their medical officers of health in connection with the provision of section 55 (4) of the Act,
which provides for the transmission of certificates relating to school children suffering from infectious
disease to the head teacher of the schools attended by the patients or by any children who are inmates of
the same houses as the patients, and asking what profit had accrued in their districts from the use made
of this information by school authorities.
The replies supplied evidence that the head teachers had been duly apprised of the existence of
such cases as required by the Act. As to the advantages which had accrued some difference of opinion
was expressed. The majority of the answers did not go further than the statement that, inasmuch as
the exclusion from school of children from infected houses had resulted, the result must be regarded as
beneficial. In a few cases it was more definitely stated that advantage had been gained, in others
that there was no actual knowledge as to the effects of the new requirement, and in two instances the
medical officer of health of the district was unable to state that any benefit had accrued to the district
from the use made of this information by school authorities.
Enquiry by the Council of the London School Board as to what information had been received
from the several districts of the sanitary authorities by the head teachers of the schools of the Board
under section 55 (4) of the Act, to what use this information had been put, and what had been the
experience of the Board of its value, led to the following report of the Board's medical officer being
communicated to the Council.
1. That the medical officers of health, without exception, send, in accordance with the
provisions of the aforesaid Act, copies of all notification certificates received by them to the
head teachers concerned.
2. That on receipt of such notification certificates the head teachers of the various departments
of the schools, have in accordance with the directions of the Board, as contained in their
code of regulations and instructions, clause 125, page 107, systematically excluded the
children from school who came from the infected houses.
3. That all such notification certificates are subsequently regularly forwarded to him by
the head teachers, endorsed by the action taken by the heads of the school departments, and
he was thus enabled to keep a correct record of the amount of notifiable infectious sickness
in connection with each school under the control of the Board.
He was of opinion "that the advantages obtained by the arrangements thus rendered possible by
the provisions of the Act above referred to, are of the greatest public benefit, inasmuch as they tend to
prevent the spread of infectious disease amongst the most susceptible class of the community, and at
the same time reduce to a minimum the necessity of interference with the educational work of the Board."
Several of the replies of the sanitary authorities touch directly upon the question whether
the compulsory notification of measles was desirable. In the district of St. Margaret and St. John,
Westminster, a system of voluntary notification of measles had been instituted by arrangement with the
majority of the medical practitioners of the district, and the medical officer of health attached great
value to this system ; the sanitary authority had therefore asked the Local Government Board to
confirm its order providing that measles should be added to the list of infectious diseases required to be
notified in the district. The sanitary authorities of St. Giles and St. Mary, Battersea, had adopted a
similar course. The Local Government Board had, however, declined to sanction such addition, stating
in their reply to the Vestry of Westminster that "the circumstances are not such as to render it
necessary that exceptional arrangements should be made as regards a particular parish in London."
A second request by the same local authority led to the reply that pending the completion of enquiries
on the subject, they (the Local Government Board) had deferred the consideration of the request.
On the other hand in several instances opinions were definitely expressed against the compulsory
notification of measles, in some on the ground that such notification would be useless unless accompanied
by opportunities being afforded for the isolation of cases of this disease.
The accompanying chart (VI.) shows the incidence of measles mortality in the period 1885-92
upon the several sanitary districts of London. The following table shows the number of deaths
attributed to this disease and the death-rates from this cause in each district in 1892.