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140
conditions rather than gravity of illness. To account or the heavy mortality in
Highgate Hospital the medical superintendent considered that overcrowding of the
wards was the most important cause. He stated that little pressure had been
expected in view of the special preparation made by the M.A.B., and that two of
the wards were out of use owing to building operations.
Furthermore, it must be pointed out with regard to the treatment of measles
at Poor Law Hospitals, that cases must be admitted to such institutions if application
is made and there is no doubt that many cases of measles were already suffering
from complications of one kind or another when admitted.
In at least two hospitals (Hospital for Sick Children, Great Ormond Street, and
East London Children's Hospital, Shadwell) special wards are reserved for the treatment
of complications associated with measles.
The question of the hospital treatment of measles is a difficult one. On the
one hand it is always dangerous to remove a person suffering from pneumonia—one
of the most grave and common complications of measles—and on the other hand
it is almost impossible to regard with equanimity the retention of such a case in an
unsatisfactory and unhygienic environment where there are no facilities for proper
care of the patient.
Reverting to the general adminstration of the measles scheme, it is necessary
to mention that in the Borough of Wandsworth special arrangements were made
with the medical officer of health whereby the health visitors met the school nurses
in consultation and were made responsible for visiting the suspicious absentees
discovered by the nurses. This system was much more effective inasmuch as it
saved time by dispensing with the visit of the attendance officers. For this purpose
five additional health visitors were temporarily appointed. Dr. Caley, medical
officer of health, was definitely of the opinion that the modified scheme had been
fully justified by the greater efficiency of the results obtained as compared with the
procedure in previous epidemics. He also pointed out that while it was not easy
to assess the effect of the scheme on the case mortality and the amount of disability
following measles, it was significent that there was a definite fall in the number of
deaths in the first six months of the year, i.e., 34 as compared with 50 in the corresponding
period of 1926, 60 in 1924, and 70 in 1922.
He added that most of the cases recovered from the disease without any complications
ensuing.
This reduced mortality, in view of the increased number of deaths in London
as a whole for the epidemic under review, seems to point to the efficacy of the
modified procedure as applied to Wandsworth.
The next epidemic of measles is due towards the end of 1929, and it is hoped
that, as a result of the experience gained in recent epidemics, the administrative
control of measles will have greater elasticity and be more efficient in its application.
Smallpox
among
schoolchildren.
Of the 305 known cases of smallpox which occured in London during the year
110 were children on the rolls of the Council's Schools. None had been vaccinated.
Parts of the boroughs of Lambeth, Poplar and Wandsworth were the chief
centres of infection and twenty-six schools were affected. In the majority of
instances the suffering child had been absent from school before the illness commenced.
Where there was suspicion or knowledge that a child had been in school
while actually sickening for smallpox, the school was placed under special medical
simervision.
A somewhat extensive outbreak of smallpox in Wandsworth in April and May
was a premonition that smallpox had come to stay and the medical and nursing
staff were warned of the need for special vigilance.
Facilities were provided by the Metropolitan Asylums Board for the Council's
medical officers working in schools to attend practical demonstrations of smallpox
diagnosis at one of the smallpox hospitals.