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34
The first objection is no doubt valid; but the same applies to
some extent to scarlatina. I am frequently having my attention drawn
to convalescing cases of this disease which have never been under
medical treatment, the acute symptoms having been brief and mild.
The same may be said of cases of diphtheria. I have no doubt that
many of the mild cases are not placed under medical treatment and
accordingly are not notified. But the notification of these two
diseases is, I believe, operating favourably in the diminution of their
prevalence.
The second is a strong objection, but it is not insuperable.
The disease is still infectious for several days after the rash appears ;
therefore, because mischief may be done before the real nature of
the disease is known, this surely is not an irresistible argument
against adopting measures which might prevent further mischief
after the disease is known.
The difficulty of providing isolation in the homes of patients is
one that we often experience during unusual epidemics of scarlatina
and diphtheria, nevertheless, where isolation is possible, the enforcement
of it diminishes to an equivalent degree the spread of the
disease. Hospital accommodation would have to be enormous,
certainly, if every case required it, but I do not think such a large
amount of accommodation would be needed. The question of
expense is obviously dependent upon the value set upon human life.
If a low estimate is held, the cost will be a bar to any effort being
made to save some of the lives which annually are lost owing to this
disease; if the estimate is a high one, the cost of increased sanitary
staff and hospital accommodation will occupy a subordinate position.
It appears from a report by the late Dr. Theodore Thomson to
the Local Government Board on the measures which might be
adopted by local authorities to control measles, that in order to
obtain the fullest control over the disease, he considered: 1. That
Measles should be compulsorily notifiable upon both medical
attendant and householder; and in order to make up for the