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highly desirable for all cases of measles recommended for removal by medical officers,
of health to be admitted to the Board's fever hospitals, and that, when measles is
epidemic, such cases shall generally be admitted to hospital in preference to scarlet
fever, if the accommodation is insufficient to provide for all scarlet fever cases. This
new scheme of hospital accommodation for measles was agreed to by the Metropolitan
Asylums Board on 16th October, 1926, and received the sanction of the Ministry
of Health. It is hoped that this extended hospital accommodation, supplemented
where necessary by the existing scheme for the provision of nursing assistance in the
home of the patient, will have the effect of reducing still further, in the next epidemic,
the mortality and complications due to measles. It is important to emphasise that
the whole scheme of dealing with measles, in the present state of our knowledge, is
directed towards the prevention of mortality and those complications which produce
such disabling effects in the sufferer, frequently resulting in prolonged attendance at
hospitals, medical treatment centres, etc.
Upon reviewing as a whole the subject of measles epidemics and the steps to be
taken in the future to mitigate the serious results accruing therefrom, it is clear that
the organisation of the public health services must be directed with due regard
to the personnel available, and concentrated upon those areas in which the special
need is acute. In the better class districts where the housing accommodation is such
as will provide adequate means of home nursing and where, in most cases, private
medical advice is sought, inquiry or assistance by public health authorities is generally
unnecessary. Every effort should, therefore, be made to concentrate attention
upon the overcrowded and insanitary areas where the housing conditions are unsatisfactory
and where it is impossible to isolate or to nurse efficiently children who
are suffering from measles. It is in these areas where the mortality and disablement
during epidemics of measles occur. It has therefore been suggested to medical officers
of health of the several metropolitan boroughs that they should classify their districts
into three separate zones for measles purposes, namely:—
Class I.—Streets or districts where there is little or no overcrowding, and
where there is a satisfactory standard of living. Children suffering from measles
in these districts would probably require no supervision or assistance from public
health authorities.
Class II.—Streets or districts where there is both overcrowding and lack of
proper nursing facilities.
Class III.—Very bad insanitary and slum districts where it is dangerous
for children suffering from measles to remain at home.
There should be no difficulty in a sub-division of this kind, as the medical officers
of health of the boroughs already classify the houses in their districts in a similar
manner in connection with the treatment of tuberculosis, and for other purposes.
It will be the object of the Council, in future epidemics of measles, to supervise
closely the schools attended by children in districts of Class II. and III. types with
the object of detecting cases of measles in the early stages and to speed up the
machinery for securing the earliest possible information of cases, in order that the
borough medical officer of health may be in a position to obtain the early removal
of cases to one of the Metropolitan Asylums Board's isolation hospitals for treatment
or, where the medical officer of health considers that satisfactory isolation arrangements
can be made at home, but where, for one reason or another, the parents are
unable to provide adequate home nursing, to offer the services of a trained nurse
during the early and critical stages of illness.
Such a scheme would involve daily visits of inspection, not only to the homes
of the children, but also to schools in the affected areas, and also perhaps to the
infant welfare centres. As was previously pointed out, the normal staffs of the
health services are insufficient to cope satisfactorily with an epidemic of measles if
the work is to be carried out efficiently. For example, the services of school nurses
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