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Measles, and as to the mortality from the disease, it is impossible to assert with
confidence that notification has enabled us to exercise any distinct and effective
control, and it can scarcely be urged that we have not made a sufficiently lengthy
trial."
The other town that tried compulsory notification was Burton-on-Trent, where
Measles was scheduled as a notifiable disease from 1894 to June, 1900. The result
there also was not deemed satisfactory. Dr. Millard, who formerly was Medical
Officer of Health for Burton, attributes this want of success to the fact that many
cases were un-reported, and also to the early stage at which Measles is infectious.
A medical attendant is not always called in where measles makes its appearance
in a family, while the householder rarely reports the presence of measles in a dwelling,
whether a doctor has been called in to see the case or not.
To this extent, therefore, compulsory notification fails to afford the Sanitary
Authorities complete knowledge of all cases that occur in their district.
Since these trials were made of the compulsory notification of Measles the
conditions have materially changed. The establishment of health visiting and the
better appreciation of health requirements which health visiting is calling forth,
the medical inspection of schools and school children, the institutional treatment
and isolation of selected patients—these and other measures have placed opportunities
in the hands of local authorities which would enable them to utilise more
satisfactorily the information obtained by the compulsory notification of Measles.
Taking, first, the effect of notification upon the epidemicity of the disease, it
is probable that the most hopeful line of action lays in the co-ordination and cooperation
of school inspection and sanitary administration.
In the schedule used for medical inspection one of the columns refers to the
diseases from which the children have already suffered. This column should prove
of immense value in the control of epidemics in schools. Under present conditions
the information as to a previous attack of measles is far from reliable, and the value
of the information would undoubtedly be enhanced by a system of compulsory
notification of the disease.
Not only in the schools, but also in the houses, additional precautions could be
carried out for the protection of susceptible children.
If by these means the inter-epidemic period can be lengthened, the benefits
would be incalculable.
Without an extended trial of a general notification of the disease throughout
London it is impossible, of course, to express a definite opinion as to the effects of
notification on the epidemicity of Measles ; but we are on safer ground when we
deal with its effects upon the case fatality of the disease during the late epidemic.
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