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Hackney.—The medical officer of health having stated that the chief objections to compulsory
notification of measles are (1) that mild cases would not be notified owing to no medical man being
called in, (2.) the early infectiousness of the disease, (3) the difficulties and cost of isolation, and
(4) the costs of notification and of the sanitary staff which would be necessary, says—
The first objection is no doubt valid; but the same applies to some extent to scarlatina. I am
frequently having my attention drawn to convalescing cases of this disease which have never been under
medical treatment, the acuter symptoms having been brief and mild. The same may be said of cases
of diphtheria. I have no doubt that many of the mild cases arc not placed under medical treatment and
accordingly are not notified. But the notification of these two diseases is, I believe, operating favourably
in the diminution of their prevalence. The second is a strong objection, but it is not insuperable. The
disease is still infectious for several days after the rash appears; therefore, because mischief may be done
before the real nature of the disease is known, this surely is not an irresistible argument against adopting
measures which might prevent further mischief after the disease is known. The difficulty of providing
isolation in the homes of patients is one that we often experience during unusual epidemics of scarlatina
and diphtheria ; nevertheless, where isolation is possible, the enforcement of it diminishes to an equivalent
degree the spread of the disease. Hospital accommodation would have to be enormous, certainly if every
case required it, but I do not think such a large amount of accommodation would be needed. The question
of expense is obviously dependent upon the value set upon human life. If a low estimate is held, the cost
will be a bar to any effort being made to save some of the lives which annually are lost owing to this
disease; if the estimate is a high one, the cost of increased sanitary staff and hospital accommodation will
occupy a subordinate position.
St. Giles.—The medical officer of health writes—
In October last your Board addressed a further communication to the Local Government Board
urging that an early decision should be given to their proposal that measles should be included in the
list of notifiable diseases.
Strand.—The medical officer of health states—
The question of adding measles to the list of diseases which have to be notified has been brought
under the consideration of your Board on several occasions in communications from other authorities,
but the reasons advanced in favour of the proposal have not been sufficiently convincing to induce the
Board to alter a previous decision that measles should not be notified.
Clerlcenwell — After referring to the fact that during the last ten years scarlet fever has caused
68 and measles 598 deaths in the district, the medical officer of health writes—
This enormous preponderance in mortality of the non.notifiable disease measles, over the notifiable
disease scarlet fever, has led to much comment, and the vestry has on more than one occasion been asked
to give an opinion as to the advisability of adding measles to the list of diseases which have to bo notified,
influenced by the belief that notification would be of little benefit without isolation, and that the difficulties
in the way of securing effective isolation cannot at the present time be wisely faced, they have without
disagreeing either with the gravity of present conditions, or the desire that they should be improved,
considered the present moment inopportune for making the proposed change.
St. George.in.the.East.—The medical officer of health states—
The question of making measles a notifiable disease was also before the committee, when it was
resolved that no action be taken. This disease is highly infectious before it can be diagnosed, and is more
fatal among children of about two years of age. In some places where this affection has been made
notifiable, it had been subsequently decided to discontinue its compulsory notification, it apparently having
no effect in modifying the mortality. For these reasons, and looking at the fact that there is no hospital
in which such cases could be isolated, it can hardly be recommended at present that this disease should
be made notifiable in this parish, although something would be gained by being able to notify the schools.
Poplar (Bow).—The following paragraph appears in the report of the medical officer of health—
Personally, I have no hesitation in expressing the firm opinion that one of the first steps should be
notification. At present measles, though classed as a zymotic disease, is not included amongst the
diseases that are notifiable under the Public Health (London) Act of 1891. So there is only the mortality
data to convey any information as to its prevalence during any given period. Desirable as it is that the
principle of providing hospital accommodation for notifiable diseases should be preserved, yet, with the
circumstances of 1896 before us, I feel inclined to modify my former opinion that notification and
hospital accommodation for measles must make their debut together.
St. George, Southward—The medical officer of health writes—
As frequently pointed out by me before, I think that the compulsory notification of cases of measles
throughout London, with subsequent hospital treatment and disinfection, could not fail in a poor parish
like St. George's to result in a great saving of life.
Newivgton.—The medical officer of health presented a special report on the notification of
measles, as follows—
At your request I have written to the medical officer of every sanitary authority in England where
the practice of having measles notified has been adopted by them. They number 54, and I have received
replies from 36. For the convenience of the Committee I have summarised the opinions expressed.
It will be seen at once that nearly the whole of the authorities who have adopted the notification are
urban, and their medical officers express views more or less in favour of having measles notified, whilst
in the very few rural authorities on the list their medical officers have hesitated to say much as to the
benefit that has been received from its adoption. The important points are these: (1) they all say that
measles is much less satisfactory in its notification than scarlet fever and other diseases on the list;
(2) that the early infectiousness of the complaint, as early even as the incubation stage, is a great obstacle
to the prevention of the disease from spreading; (3) that effective isolation in hospital would be too
costly for many authorities to bear; (4) that many think it is a very good thing to have notification, even
if you have not hospital accommodation, as the cases have so much better attention and care when visits
are made to them by the officials of the authority; (5) that the feeling in the matter is highly progressive,
in the way that all infectious diseases, it is thought, ought to be reported to the local centre ; (6) that if
the full notification of all the cases is expensive, the first case in the family might be the one alone
notified. Personally I think that if any district could be benefited by this notification, it is ours, with
its poor and overcrowded population.
If the notification embraced all the cases, I estimate the number to be 1,500 in the year, but if only the
first cases, 400. I would advise the Committee to recommend that only the first case in the family be
paid for ; and to support the petition to the Local Government Board with that qualification.