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104
The largest number of deaths in London from measles
in the decennium 1882-91, was recorded in 1890, viz., 3291;
the lowest in 1891, viz,, 1807. In every other year the
deaths considerably exceeded 2000. In 1890 the deaths in
the four quarters successively were 338, 982, 937, and 1034.
The cases in this year, assuming a mortality of 3 per cent.,
would have been 110,000, whereas the cases of the eleven
notifiable diseases were only 29,795: in 1891 they were
26,522. It is manifest, therefore, that if measles should
be dealt with like scarlet fever, viz., by visitation of the
cases, by removal of the sick to hospital when necessary, by
disinfection, and by reports to the head teachers of schools,
an enormous amount of work would be thrown upon sanitary
officials, whose numbers would have to be largely
augmented. It is a question whether all this trouble and the
increased outlay (including the notification fees) might not be
wisely incurred, if only for the purpose of securing exclusion
from school of children living in infected houses? The
disease would spread, as now, in houses where it found an
entrance, but if it were recognised in time, and exclusion
from school insisted upon, many households might escape,
which, under present circumstances, would almost certainly
be invaded. Unhappily, however, there is little in the earliest
stage of many cases of measles to differentiate it from a
common cold, and it is but too probable that at the commencement
of an epidemic some of the sufferers would go to
school, and so spread the disease. Once fairly set going it is
practically impossible to stop an epidemic: the fire burns
fiercely while the fuel lasts, but that is not for long—in other
words, well-nigh all susceptible children in the crowded homes
of the poor fall victims to the disease within a few weeks of
its appearance in the locality, or in the large public elementary
schools.
But whatever opinion may be formed as to the policy of
making measles a notifiable disease, there can be no doubt