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134
an important factor in the spread of diphtheria and consequently in the causation
of much preventable loss of young lives.
Measles.
Review of
1927-28
epidemic.
Epidemics of measles appear with regularity every two years. They usually
commence in the latter part of the autumn and continue to prevail until the susceptible
material, that is to say children who have not previously suffered from the
disease, has been exhausted, up to a point where the ratio of immune to non-immune
persons is sufficiently high to withstand the "infection pressure." This process
usually takes about six months from the start of the epidemic. During the succeeding
eighteen months the proportion of susceptible children gradually rises again,
mainly as a result of new births, until the loss of "mass immunity" reaches a point
conducive to rapid spread of the disease. The result of observation on children of
school age has shown that it is necessary for at least one-third of the children to be
susceptible before measles spreads. Although cases of measles occur endermically
during this non-epidemic period, the general incidence of the disease remains fairly
constantly on a low level, and the number of deaths are more or less negligible
During time of prevalence the disease tends to become more virulent as the epidemic
curve rises and the result is reflected in the mortality figures, especially among
children under 5 years of age.
It has to be accepted that every method of control which has essayed to check
the spread of measles during epidemics has failed. The investigations of the Ministry
of Health into methods of immunisation against measles, to which reference is made
in my report of 11th November, 1926, has not yet provided a solution of the problem.
This means of protection is provided by the use of serum obtained from convalescent
cases of the disease, and it will thus be obvious that, as applied to the community
in times of epidemics, the employment of such a measure is impracticable.
Fortunately, however, much amelioration of the consequences of an epidemic
is possible by means which are at the disposal of Public Health authorities.
Epidemics have always been accompanied by high mortality, and it is the aim
of the Council, in co-operation with the metropolitan borough councils, to concentrate
upon the prevention of the complications of measles which too often bring
death or serious injury to those children who do not receive proper medical attention
and efficient nursing at an early stage of the illness.
Ignorance or apathy of parents with regard to the serious nature of measles
(not only among the very poor) and congestion of population contribute to the
risks of children.
Many suffering children would fail to receive the timely succour which is available
to the public if they were not diligently sought and speedily found in school
and in the home by teachers and school nurses, by attendance officers and by the
officers of the borough councils.
The
incidence of
and mortality
from measles
during the
1927-28
epidemic.
The true incidence of measles cannot be estimated with any degree of accuracy
owing to the fact that it is not a notifiable disease except in two boroughs (Paddington
and Fulham), and in seven boroughs as regards the first case in a household (Greenwich,
Hampstead, Lambeth, St. Pancras, Southwark, Battersea and Finsbury).
Even if it were generally notifiable a considerable proportion of cases would doubtless
escape notification owing to the disinclination of many parents to consult a doctor
when their children contract measles which is commonly regarded as a trivial complaint,
whereas in fact it is responsible for more loss of life during the biennial
epidemics than scarlet fever and diphtheria combined.
A reasonable estimation of the prevalence of the disease is, however, obtainable
through the reports received from head teachers of the Council's schools. The
1927-28 epidemic may be said to have commenced about the end of November when
the school notifications commenced to rise above the normal. It reached its culmination
about the third or fourth week in March when 2,807 cases were reported (week
ending 24th March). The epidemic did not actually subside until about the end
of June. It must, however, be realised that the disease was not prevalent