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north, Islington and to a less extent, St. Pancras and Hackney were involved ; the
disease was also mildly prevalent in the East-end. As in the case of diphtheria, the
western districts, with the exception of Fulham, were not specially affected. The
number of schools visited by the Council's medical officers for the purpose of investigating
the occurrence of scarlet fever among the pupils was 204, entailing 358
departmental investigations and the inspection of some 46,000 children.
Measles.
Method of ascertainment of cases.—The means adopted for ascertaining the
existence of measles, involving the question of compulsory notification of the disease,
has been made the subject of reports from time to time. Compulsory notification
has frequently been imposed in different parts of the country by local orders, and
has generally been abandoned because the advantages gained have not been commensurate
with the cost involved. In 1915 measles and German measles were
made compulsorily notifiable throughout England and Wales by the late Local
Government Board, the notification being limited to the first case in a household.
The Order was, however, rescinded in 1919, and a memorandum was issued by the
Ministry of Health pointing out the ineffectiveness of the Order and indicating
the more practical measures which should be adopted by local authorities in combating
the disease.
In London the chief means of obtaining knowledge of cases of measles is secured
through the school organisation. Although, in certain metropolitan borougha,
measles is still compulsorily notifiable, the weight of opinion inclines to the view that
the combined efforts of the head teachers and school attendance officers, supplemented
in times of special prevalence by the assistance of school nurses, provide the best
and most practicable means of securing knowledge of cases as they occur. The
information thus obtained is immediately forwarded to the school medical officer
and to the medical officer of health of the borough concerned, in order that the
latter officer may provide nursing assistance, where necessary, and select cases for
removal to hospital. Further details of the procedure are later referred to under
the heading of "Administrative measures."