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The total number of cases of measles and German-measles reported as occurring among school
children during 1918 was 13,260, as compared with 29,112 (uncorrected) among persons of all ages
(including children under school age) notified in accordance with the Public Health (Measles and German
Measles) Regulations, 1915.
Measles and
German
measles.
The incidence of measles was comparatively low throughout the year, the highest recorded
weekly number of cases in the schools being 630 for the week ending 30th June. There was evidence
towards the close of the year, however, that measles was becoming more prevalent. The rise in the
incidence of the disease commenced about the middle of November, but the indications of serious spread
did not become apparent until the end of January, 1920, and at the time of going to press (April) measles
has reached epidemic proportions.
During the year, unprotected children were temporarily excluded from 426 classrooms, whilst,
in 80 schools all children under five years of age were excluded for appropriate periods.
Towards the end of 1919, the notification of measles came under review of the Ministry of Health
and on 27th November, 1919, a general Order, addressed to local sanitary authorities throughout England
and Wales was issued, rescinding, as from the 31st December, 1919, the Public Health (Measles and
German Measles) Regulations, 1915, which made compulsory the notification of cases of measles and
German measles as from the 1st January, 1916; the notification requirement in the latter Order was
limited to the first case occurring in a household as far as the medical attendant was concerned, but
householders were required to notify every case. The new Order was accompanied by a memorandum
in which the Ministry pointed out that various criticisms had reached them as to the ineffectiveness of
the Order of 1915, and that it had been concluded that compulsory notification was not the best method
of dealing with the problem of the control and treatment of measles. On the other hand, it was demonstrated
in the Memorandum that there were many other channels of information through which medical
officers of health received information of cases of measles, i.e., from school teachers, school attendance
officers, health visitors, etc., and it was expected that the withdrawal of the Notification Order would
leave local authorities free to organise their existing resources with a view to combating the spread of
the disease and mortality arising therefrom. In this connection I circularised the medical officers of
health of the metropolitan boroughs with a view to ascertaining what measures were being taken to
provide for nursing assistance of cases of measles and whooipng cough, and the replies received indicated
that the provision of nursing care is being generally dealt with in London.
The Memorandum deals with the subject under three broad headings as follows:—
Section (1) sets out in more or less general terms the local administrative action which should
be taken, i.e.:—
(i.) Advice and instructions to parents on the importance of treating measles seriously, by
means of posters, pamphlets, etc., the practical advice of health visitors, lectures by medical
men and by such other practical methods of influencing the public attitude on the subject.
(ii.) The efficient organisation of visiting by qualified health visitors with a view to securing
that necessary steps are taken to secure medical and nursing treatment where necessary, and
generally to advise on such ameliorative measures in the home as may be required. The
utilisation of the services of health visitors employed in maternity and child welfare is indicated
in this connection.
(iii.) Emphasis is laid on the necessity for making proper provision for nursing assistance
through district nursing associations or by employing nurses of the sanitary authorities' isolation
hospital staff. It is pointed out that contiguous local authorities may usefully combine for
such purpose or that a more economical arrangement would be for the County Council to provide
a staff of nurses for visiting and nursing cases of measles and other infectious diseases, such as
whooping cough, poliomyelitis, epidemic diarrhoea and ophthalmia neonatorum in children
under five years of age throughout the county.
(iv.) Indicating the need for providing medical assistance for necessitous cases at the
expense of the local authority.
(v.) Institutional or hospital treatment is advised as being specially desirable in certain
instances, particularly in severe cases or where the home conditions are unsatisfactory. In
London the Metropolitan Asylums Board are empowered under an Order of the Local Government
Board (1911) to receive cases of measles in isolation hospitals upon recommendation of
the borough medical officer of health.
(vi.) Convalescent home treatment is recommended in special cases and local authorities
are urged to make the necessary provision in this connection either by direct means or through
voluntary agencies.
(vii.) The necessity for the after-care of children who have been suffering from measles
is emphasised as measles is often followed by more or less prolonged periods of ill-health.
The desirability of keeping such children under medical observation at child welfare centres
and school clinics is indicated.
(viii.) Attention is directed to the dangers arising from measles and other infectious diseases
occurring in day nurseries, creches and children's institutions generally, and to the need for
the authorities responsible for such institutions consulting the medical officer of health or
responsible medical officer with regard to the risks in this connection.
With regard to (viii.) at the present time there are eight recognised nursery schools in London,
all conducted by voluntary agencies, and proposals are under consideration for establishing a number
of other such schools under the jurisdiction of the Council for children below five years of age. In the
Regulations for Nursery Schools issued by the Board of Education in 1919 it is stated that the school
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