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Compared with the undermentioned foreign cities the death rate in London from measles has
been in excess of the majority both in the period 1884-93 and in the year 1894—

The greatest incidence of measles in London has, in 1894, been upon the eastern districts, and
upon those of the southern districts of London having a population containing many poor. The increase
in the year has naturally led to the further discussion of the value of notification of measles as a means
of limiting the extension of the disease. It will be recollected that the London School Board in 1892
addressed a letter to the Council expressing the opinion that such notification should be made compulsory
in London, and that, after communication with the Local Government Board, the Council resolved
to postpone discussion of the question until that Board had completed an enquiry which it had undertaken
with a view to ascertaining the value of notification of measles in urban communities. It may
be expected that such inquiry will include an investigation into the results obtained by certain
authorities who have limited their requirement of notification to the first case occurring in a house or
family. In view of the information contained in the reports of London medical officers of health as to
the diffusion of measles by school attendance, there is need of some system which will give better
opportunity for the exclusion from school of children living in infected houses.
The chief points referred to in the reports of the medical officers of health are as follows—
Kensington—The medical officer of health in discussing the effects of epidemic prevalence of
disease on school attendance says, " It is surprising to what an extent the attendance in the infants'
department of elementary schools is reduced during the currency of an epidemic of measles. In one
large school in this parish during the three weeks ended June 2nd the absentees were 50 per cent. of
the children, viz., 260 out of an average number of 523 on the roll. But not all the children were
absent on account of being ill with measles, some having been kept from school owing to the infection
in the houses wherein they resided, and some, of course, from other causes." In discussing the
question of hospital provision he expresses the opinion that many lives might be saved were it practicable
to isolate in hospital children suffering from measles, " especially such as live in overcrowded
houses tainted with foul air, and under conditions which preclude the care so necessary in the nursing
and management of measles." He refers to the requirement of the London School Board that children
living in infected houses shall not attend the Board's schools, and to his suggestion made in 1890 that a
circular letter informing parents of this requirement should be sent to the parents of pupils, a course,
he says, which was not adopted. " Such a communication, if systematically made at the beginning of
an epidemic of any infectious disorder, would probably be the means of saving many lives ; it would
certainly have the effect of checking the spread of measles in the only practicable way short of closing
schools."
Fulham—The medical officer of health referring to the prevalence of measles in the district
during the year says that " the epidemic began in the southern part of the parish, among the children
attending the Langford-road Board School, which was, at the request of the sanitary authority, closed
from March 1st to March 28th with apparently good effect to the district served by it." In discussing
the question of notification of measles, he estimates that the deaths in Fulham from this cause, some
160 in number must have represented 4,000 cases, and says the results of notification in other communities
do not seem, in the absence of isolation hospitals, to be commensurate with the heavy outlay incurred.
But he refers to a modified system of notification by which the first attack in every house only is notified,
and states his opinion that this, at any rate, would have the effect of impressing parents with a
sense of the serious nature of the disease, and would give better control over the attendance at school
of children from infected houses. Commenting on the heavy mortality among children unfavourably
circumstanced, he expresses the hope that some hospital provision for such cases will before long be
provided.
*See footnote (*), page 8.