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By 1931 the following conclusions could be drawn from previous experience :
(i) Measles epidemics occurred every two years in London, commencing in the
autumn and lasting for six or seven months.
(ii) The only means of preventing a measles epidemic was by the use of serum,
but, owing to practical difficulties, this preventive could, at that time, only be applied
in very restricted communities (hospitals, residential schools, etc.).
(iii) The incidence was greatest in the age groups 1-5, and the deaths highest in
the age groups 1-3.
(iv) Practically all measles deaths resulted from complications (bronchopneumonia
especially) which were to a very large extent avoidable if patients
obtained adequate medical and nursing care.
(v) Children were not sent to hospital until complications had arisen.
(vi) The younger the child, the greater the risk of serious illness from
complications.
Measles again became notifiable in London in 1938 and for control purposes the
results were immediate. Before any records of epidemiological value could be accumulated
however, the normal biennial rhythm of attack was disturbed by the evacuation
movements of 1939 and subsequent war years and in the years after 1940 the attacks
were annual and of the same order of magnitude every year. In 1951, it was reported
that the rhythm of measles epidemics was then moving towards a biennial period such as
had existed in the period 1923-38.
Before 1938, records of incidence were built up from reports of absences from
school, from hospital admissions and from mortality records. Up to the outbreak of the
1939-45 war, biennial epidemics were of such magnitude that more than 70 per cent. of
children suffered an attack before the age of 15. In 1949, it was stated that the overall
incidence had been reduced to such an extent that the risk of attack before the age of 15
had fallen to 60 per cent.
Most deaths from measles are due to respiratory complications, and the more recent
reduction in mortality can largely be attributed to the use of the sulphonamides and
anti-biotics in the prophylaxis and treatment of the respiratory complications.
Like measles, whooping cough was often a fatal disease for very young children at
the time of the transfer of the powers of the London School Board to the Council. The
fatality from this disease, which has been declining since the end of the last century, has
fallen with dramatic rapidity in more recent times. Immunisation against whooping
cough is kept under close watch with a view to the establishment of arrangements
similar to those for diphtheria as and when medical developments justify it. Parents who
ask to have their children immunised against whooping cough can have it carried out
free at a session in one of the Council's centres by arrangement, and the Council pays the
standard fee for records of such immunisations received from eeneral practitioners.
Whooping
cough
Mention has already been made of the appointment by the London School Board,
in October, 1901, of the first school nurse, who was soon nicknamed the ' ringworm
nurse'. At that time, ringworm kept thousands of children away from school for long
periods and was one of the diseases considered by the Special Sub-Committee on the
Treatment of School Children (referred to in the section on ' Medical inspection and
treatment'). The disease was the chief trouble the nurses had to contend with, the
resources of the hospitals being inadequate to deal with the problem.
In 1906 it had been shown that ringworm cases corresponded to a school absence
involving a loss of fee grant of between £5,000 and £6,000 annually and this meant an
average of 2,950 children out of school. Subsequently, the Attendance Department
ascertained that the average number absent at any time was about 3,500 to 4,000. In his
annual report for the year 1911, the School Medical Officer stated that, in recent years,
there had been about 6,000 new cases annually. When the treatment scheme became
established, an enquiry by the nurses, who filled up a card for each case, showed 3,542
cases, of which 446 were being treated by Roentgen rays.
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Ringworm