View report page

31
1911, it reached 46.3 as against 128 for the whole of London. This result bears ample
testimony to the value of the work done, and I may add that during the hot months,
May to September, only five deaths from diarrhoea or enteritis in infants were registered
in the City.
COMPULSORY NOTIFICATION OF MEASLES.
During the year, compulsory notification of measles has again received the consideration
of Public Health Authorities. From time to time the principle is advocated,
such advocacy almost invariably coinciding with outbreaks of the disease.
In the City, public attention was called to the matter, in connection with an inquest
held at the Coroner's Court on the 29th December, 1910, on the body of a female child,
aged 2½ years, who died from Broncho-Pneumonia, following measles, and accelerated
by shock from scalds, the jury appending to their verdict the following rider, viz.:—
"And the Jurors advise compulsory notification of the malady known as
"Measles, throughout London, followed by disinfection of premises, and
"also hospital treatment by the Metropolitan Asylums Board for poor
"children, such as the deceased, suffering from the disease."
Whilst the adoption of any measure that may be likely to limit the spread of any
infectious disease is desirable, investigation of all the factors concerned is essential
before expressing any opinion as to the advisability or otherwise, of making notification
of any particular disease compulsory.
Measles is a specific infectious fever, attended by a characteristic eruption and
catarrh, affecting chiefly the respiratory, nasal and ocular mucous membranes, and with
the possible exception of Whooping Cough, one of the most infectious of the specific
fevers. Moreover, it is the cause of more deaths than either Scarlet Fever or
Diphtheria, and for these reasons its notification has been adopted in various places
during the past 20 years.
The expenditure involved, however, proved so considerable, and the results
obtained were attended with so little success, that this method of dealing with the
disease was generally abandoned.
Nearly all children are attacked by Measles within the first ten years of life, while
probably half the patients do not get medical attendance.
It is obviously impracticable to make notification of infectious diseases compulsory
when a medical man is not consulted, as a non-medical diagnosis would be valueless,
and it is clear that no penalty relative to the notification of infectious diseases could be
enforced in the absence of medical evidence as to the nature of the disease.
If medical attendance could be assured in all cases, the notification of Measles
under such improved conditions might possibly be useful from a statistical point of
view, but it is difficult to see of what service it could be in limiting the spread of
infection, as the rash does not appear until the fourth day of illness, and the disease
is certainly infectious before the appearance of the rash, and has in all probability spread
to other unprotected children in the house before it is recognised. It would certainly
be desirable, if practicable, that the first case in each house should be reported, as the
sanitary authority might then have some chance of limiting the spread of infection.