London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1896

[Report of the Medical Officer of Health for London County Council]

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The vestry, after a discussion, decided not to petition the Local Government Board, as it was
thought not advisable to have measles included in the list of infectious diseases compulsorily
St. Olave.—The medical officer of health expresses the following opinion—
Hospitals for those cases that cannot be isolated at home and for those that cannot receive proper
nursing and treatment at home, which is usually the case in crowded one or tenements, are
very much required, and would be the means of very much reducing the death.rate of this disease.
Notification by the head of the family should be compulsory, so that children from infected houses
could be excluded from school.
Lambeth.—The following paragraphs appear in the annual report of the medical officer of
It is perfectly true that measles causes a large number of deaths yearly, and it is also true that the
notification of measles might be useful in the sense that infected houses would be visited, and insanitary
conditions (when found) remedied, children more rigorously (than at present) kept from school, infected
houses be disinfected, and the officers of a sanitary authority brought more into contact with the mothers
of infected children, and so a process (slow though it might be) of education in sanitary matters, and in
the dangers and proper treatment of measles, result; but whether the good that would accrue in this
way would be at all proportionate to the expense, is quite another matter, and one that needs the careful
and serious consideration of an officer of health before he ventures to advise his authority to incur it,
more especially when we consider the peculiarities of this particular disease, and the difficulties already
pointed out in connection therewith. Further, a large increase in the sanitary staff would be necessary
for the purpose of carrying out this additional inspection of measles.infected houses, and for the
proper carrying out of the subsequent disinfection. To sum up the matter shortly, it may be stated
that simple notification of measles is not advisable, and that notification followed by isolation, disinfection
&c., impossible at present (at least in London) conclusions which appear (to me at least) to be borne out
by the experience of those sanitary districts that have already adopted measles notification. I may add
that I am satisfied from experience that the early closure of schools (more especially the infants' departments)
at the commencement of an epidemic is of the very greatest use, and this can be effected by a
system of simple notification between the school authorities and the medical officer of health.
Theoretically, notification under the Act is necessary, followed by isolation, disinfection, &c.,
practically it is not advisable in London, at least, at the present time.
Battersea—The medical officer of health writes—
Thus from the two diseases combined (whooping cough and measles) 325 deaths occurred, comparing
most unfavourably with a total of 151 deaths from all the notifiable zymotic diseases, an unanswerable
argument in favour of the compulsory notification of all infectious diseases, they, in the pre.notification
period, being said to be equally intractable to supervision and modification, an idea which the greatly
diminished case mortality demonstrates to be incorrect.
Wandsworth.—The medical officers of health in their joint report, in referring to the increased
mortality from measles in this district write—
We again point out, as in our report for 1895, the importance of something being done to stop this
excessive mortality. It is largely a matter of educating the poor as to the necessity of taking care of
measles. This we hold could be to some extent accomplished if we knew of cases of measles; at present
we hear only of deaths.
Plumstead.—In reference to the notification of first cases of measles in houses as distinguished
from the notification of all cases of measles the medical officer of health says—
It is doubtless true that in a disease like measles the onset of which is difficult to recognise, but
which is very infectious in the early unrecognised stage, we cannot hope to diminish its prevalence to
the same extent as in scarlet fever. But I believe a good deal can be done and if only a few lives can be
saved every year, no pains and no moderate expense should be spared. I have never yet advocated the
general notification of measles, as it appears doubtful from the experience of places where it has been
tried whether the results are commensurate with the expense. It has been proposed lately that the first
case only in a house should be notified and paid for. This plan would no doubt be very advantageous
and much less expensive than a general notification, but I think it would not be enforced under the
present Public Health Act. It might however be made voluntary, 2s. 6d. being paid for the notification
of each first case in a house. Bnt the great difficulty is the fact that probably in the majority of cases
of measles no doctor is called in.
Scablet Fever.
The cases of scarlet fever notified in the Administrative County of London in 1896 numbered
25,758, compared with 19,808 in 1895. The number of deaths registered from this cause in 1896 was
941 giving a death rate of 021 per 1,000 living per annum.
The London rates in 1896 and previous periods are shown in the following table—

Scarlet fever.

Period.Death rate per 1,000 living.Case rate per 1,000 living.Case mortality per cent.

(1) See footnote (1), page 7.