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32
Direct contact with a case of Measles is undoubtedly the most important factor in
the spread of the disease, and on this account, notification and removal to hospital with
consequent isolation, would at first, appear desirable. On consideration, however, it is
clear that the segregation of cases would be of little or no advantage as this disease is
infectious in its pre-eruptive stages, and a child may be the carrier of the disease,
infecting those with whom it comes in contact before it presents any definite indication
of the malady.
Again, the fact that so large a proportion of those attacked are infants, and would
have to be accompanied by their mothers, presents a serious difficulty in relation to
hospital accommodation.
Obviously, school attendance affords opportunity for the spread of infection, and
on this account active steps are taken by School Medical Officers of the London County
Council to exclude unprotected children from school immediately a case of measles
occurs.
Notification of all such exclusions in London is forwarded to the Medical Officer
of Health, and by these means, to some extent the risk of infection may be minimised.
Practically all children get Measles, and this fact is generally urged as an argument
against notification, but while there is some degree of strength in such argument, the
fact must not be overlooked that it the attack is postponed until the later years of
childhood, the case mortality is much reduced.
In the case of a disease so infectious as Measles, a disease which is directly and
indirectly responsible for so large a percentage of infantile deaths, it is advisable that
wherever possible, restrictions should be imposed with a view to preventing the spread
of the infection, but having regard to all the circumstances in connection with measles,
I am unable to endorse the rider of the jury previously referred to.
I am of opinion, however, that if Sections 60, 61, 62, 63, 64, 65, 68, 69, 70, 72,
73 and 74 of the Public Health (London) Act, 1891, were applied to Measles, such
would to some extent contribute to the reduction of the number of cases. These
Sections deal with the disinfection, shelters, clothing, infected rubbish, letting of
houses, wilful exposure, transmission of infected clothing, milk and fruit trades, use of
public conveyances, burial of dead, removal of corpses, use of hearses.
As a matter of fact the precautions such as disinfection and removal of families to
the City Shelter, after cases of Measles that come to our knowledge, have been the
practice in the City for many years.
On the 13th March, in view of the special prevalence of the disease, a conference
was held at the Local Government Board, which was attended by the Medical Officers
of Health of the Local Government Board, the London County Council, the Metropolitan
Borough Councils, and the City of London, to discuss the possibility of adopting
further preventive measures.
The Local Government Board issued a Memorandum on the subject which is here
reproduced in full.
"Measles in London."
"I am directed by the Local Government Board to state that they have had under
"consideration the present outbreak of Measles in London, and that on the suggestion
"of the President, their Medical Officer has conferred with the Medical Officers of the
"London County Council and of the various Borough Councils as to the measures
"which may be taken for dealing with it.