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treatment of measles. On the other hand, it was pointed out by the Ministry that there
were many other channels of information through which medical officers of health
received information of cases of measles, i.e., from school teachers, school attendance
officers, health visitors, etc., and it was expected that the withdrawal of the Notification
Order would leave local authorities free to organise their existing resources with a view
to combating the spread of the disease and the mortality arising therefrom. In this connection
the School Medical Officer circularised the borough medical officers of health to
ascertain what measures were being taken to provide for nursing assistance in cases of
measles and whooping cough and the replies received indicated that, generally, the
provision of nursing care was being dealt with in London.
A scheme was drawn up in consultation with the Education Officer for the more
effective control of measles in public elementary schools by expediting where possible
the ' voluntary ' notification of cases of the disease (in addition to compulsory notification
in those London boroughs which had decided that this should remain in force) thus
enabling local sanitary authorities to put into operation their arrangements for nursing
provision and ' following up ' at an earlier date than would otherwise have been possible
in many instances. The scheme involved close co-operation between the school nurse,
head teacher, school attendance staff, and the public health staff of the borough. It was
proposed in the scheme to pay special attention to the children under five years of age.
As time passed, experience showed that the policy of school or class closure was
valueless, as closure was not resorted to until the outbreak had become well-established,
and by that time the damage had been done, all the ' susceptibles' having already been
exposed to infection.
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. At a conference,
on 25th February, 1921, there was a general measure of agreement with the
Council's scheme for dealing with measles, which on the one hand, involved the fullest
utilisation by the Borough Councils 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 was reported by the School Mcdical
Officer in the annual report for the year 1925 that this procedure had been applied in
successive epidemics in recent years and that there had been a concurrent decline in
mortality from the disease. It was also stated in the same report that the most effective
of the administrative steps taken to reduce the mortality from measles had been the
attention to, and nursing of, sick children in hospitals or in their homes. Owing to the
1914-18 war, conditions were very adverse in the poor quarters of London and the
mortality from measles in particular was excessive in these areas in the winter of 1917
(before the food supply was brought under control) and it is probable, but for these
adverse conditions, that the reduction in the measles mortality would have occurred
earlier. With rationing of food and the decline of the birth-rate conditions altered for
the better, both for the children and the mothers. Although, therefore, a good deal could
be accomplished in reducing mortality, experience showed that, in spite of all efforts,
little could be effected in the way of checking the incidence of the disease when it became
epidemic.
As a result of observations of the working of the scheme inaugurated in 1921 the
principle was adopted of concentrating upon the crowded, insanitary and slum areas,
where, owing to want of medical attention and proper nursing, measles mortality was
notoriously high, and paying less attention to the better-class residential areas where
parents were better able to afford the services of a private doctor.
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