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29
Measles.—Towards the end of the year, an epidemic of Measles made its
appearance in the District, and subsequently, I made a report to your Health
Committee upon the notification of this disease, the arguments for and against
which are here summarised. '
A.—The arguments in favour of the notification of measles are:—
(1) Measles causes a larger number of deaths than any other zymotic
disease, excepting whooping cough and diarrhoea.
(2) It is highly infectious, and the infectiousness continues after the
appearance of the rash, and until the branny desquamation ceases.
(3) It is largely spread through the medium of schools, and it is too
late to close schools after the disease has obtained the hold shown
by the death returns.
(4) The protection of schools and the prevention of epidemics would be
furthered by enabling infected children to be detained at home,
and by affording earlier opportunity to send printed and other
instructions for dealing with the disease and preventing its spread.
(5) Notification would enable isolation in hospital and disinfection of
the dwelling-room, &c., to be carried out. This would (a) check
the spread of the disease, (b) tend to reduce the virulence of the
disease by improving the surroundings, and (c) diminish the
fatality by improved treatment, and (d) as measles only lasts half
as long as scarlet fever, twice the number of patients could be
treated in the same number of beds.
B.—The arguments against the notification of measles are: —
(1) The maximum mortality of the disease is during the second year
of age, rapidly diminishing though childhood till it becomes
insignificant, although this may be due to acquired immunity, but
the fatality averages only about 5 per cent. of cases.
(2) The disease is infectious before the characteristic rash appears, and
during the corhyzal stage.
(3) It mainly prevails among children before school age, and becomes
more or less epidemic every other year, with extended epidemics
every few years.
(4) In the majority of cases medical advice is not sought; these cases
would therefore not be medically certified, and, if notified by
parents and guardians, medical examination would have to be
compulsorily enforced to verify the fact.
(5) Admitting that (a) isolation checks the spread, not only of measles,
but also of even the most benign communicable ailments, (b)
improved surroundings reduce the virulence of all diseases, and
(c) improved treatment reduces the fatality of all diseases, and that
all these are desirable aims; still the great objection to notification
is that (d) effective measures of isolation in hospital and disinfection