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accept any excuse as to the child's absence from school, except a written one, it
would be more difficult for the parents to afterwards deny the existence of the
disease.
During the school holidays, we are without even this meagre information.
For the above reason alone, the order of the London County Council is, in
my opinion, of no great value, and it must be admitted that it has as yet
shown no tendency to lessen the incidence of the disease in this Borough.
It would, of course, be expensive to make measles a notifiable disease, and
it is doubtful whether the expenditure would be justified if adopted. It is true
that it has been tried in many of the large provincial towns, but the conditions
are somewhat different. In all places where the experiment has been
made, a certain number of patients at the onset of an epidemic were removed
to the fever hospitals. During the height of the epidemic, the hospital
accommodation was found to be inadequate.
The Metropolitan Asylums Board, however, do not admit patients to
their fever hospitals, if they are known to be suffering from measles.
In considering the question of expense, the amount now paid to medical
men for notifying infectious diseases would be doubled. This would be a small
matter compared to the sum that would be necessary to provide sufficient
hospital accommodation. Even with a sufficient number of Fever Hospitals, we
could not expect to have the same good results with respect to measles, as
we have in the other notifiable diseases. The children that contract measles
are generally younger than those who suffer from scarlet fever. Thirty-two per
cent. of the children that died from measles in this Borough in 1909 were
under one year of age. Ninety per cent. of the remainder were between one and
two years of age. The majority of the children that died from scarlet fever and
diphtheria were between two and five years of age, and 15 per cent, were above
five years of age. The objection to removing children under a twelvemonth old,
or even under two years of age to a fever hospital, is obvious.
Measles differs from other notifiable diseases in the fact that it is very
infectious before the rash appears, and days before the disease can be recognised
with any certainty.
The removal of children suffering from measles to fever hospitals being
thus out of the question, it may be asked whether notification without subsequent
removal would be of any benefit.