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102
Administrative measures.—Various methods have been attempted from time to
time to arrest outbreaks in London schools, such as closure of affected classrooms,
exclusion of "unprotected" children, etc., with little measure of success. The chief
difficulty, as previously stated, is the extreme infectiousness of the disease for some
days before the rash appears, and this renders hopeless any attempt to control the
disease by comprehensive measures of isolation. Much can be done, however, in
the way of prevention of complications and reduction in mortality, by energetic local
action in the direction of home nursing and treatment of sufferers, combined with
the removal to hospital of the more serious cases, especially those living under unhealthy
conditions. The need for utilising to the fullest possible extent the administrative
powers and machinery, both central and local, for securing the fuller control
of measles, led to concerted action by the Council and the metropolitan borough
councils five years ago, when a conference was held (25th February, 1921), between
representatives of the Council and the metropolitan borough councils, with a view
to ascertaining what practical steps could be taken to secure the fuller control of
the disease.
The Council's existing scheme of dealing with measles had actually been in
operation before the conference was held, and there was a general measure of agreement
with the scheme, which involves the fullest utilisation by the borough councils,
on the one hand, of their powers under the Public Health (London) Act, 1891, and
the Maternity and Child Welfare Act, 1918, for giving all possible assistance in the
matter of providing nursing and medical treatment, in co-operation with the Central
Council for district nursing and local voluntary nursing associations; and by the
Council, on the other hand, in providing all possible facilities of its school
organisation, involving the co-operation of head teachers, school attendance staff
and school nurses in bringing cases of measles to light and reporting them to the
medical officer of health of the borough concerned. It is sufficient to say that the
procedure has been applied in successive epidemics in recent years, and that there
has been a concurrent decline in mortality from the disease, as will be noted in
the table on page 100 and in the diagram on page 101.
There is no doubt that greater care in the nursing of patients supplemented
by extended hospital accommodation, combined with propaganda in the schools
and homes, must inevitably have an ameliorative effect upon the mortality returns.
During the five months ended 31st March, 1926, whilst the epidemic was in progress,
the measles scheme was put into operation in 761 schools. Apart from these
measures head teachers take various precautions in the schools when measles occurs,
including the distribution of warning cards to children who have not previously
had measles.
Hospital Accommodation.—The accommodation provided by the Metropolitan
Asylums Board for the treatment of cases of measles, although limited, is utilised to
the fullest extent. Since 1912 the Metropolitan Asylums Board have been authorised
to admit non-pauper cases of measles, but it is only intended that the more serious
cases, and those living in overcrowded and insanitary homes where proper nursing
is not possible, shall be so accommodated. The selection of cases for hospital treatment
is left to the medical officer of health of the borough. As showing the increased
accommodation provided by the Board for such cases in recent years, it may be
mentioned that in 1920, when measles was epidemic 234 cases were admitted to the
Board's hospitals during the three months when the disease was most
prevalent; in 1924, another epidemic year, the number of admissions in three
months reached a total of 2,981. During the last epidemic, 2,556 cases of
measles were admitted to the Board's hospitals between 1st November, 1925, and
27th March, 1926.
The following figures relating to London as a whole show the number of deaths