Report on the recent epidemic of measles in Brighton, with a discussion of the possibility of the employment of further measures for preventing the high mortality from this disease / by Arthur Newsholme.

  • Newsholme, Arthur, Sir, 1857-1943.
Date:
[1893]
Catalogue details

Licence: Public Domain Mark

Credit: Report on the recent epidemic of measles in Brighton, with a discussion of the possibility of the employment of further measures for preventing the high mortality from this disease / by Arthur Newsholme. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    [ -5 ] Now the number of deaths from Measles during last year was 117. This would represent an apparent mortality of 9*2 per cent. What the real mortality was is somewhat doubtful. If we assume the case-mortality to be 3*1 per cent., as in Edinburgh during ten years, then the total number of cases in Brighton last year was 3,770, of which 2,494 escaped notice. This being the case, it is not surprising that the visits twice a week to houses where Measles was known to exist, to ensure that the affected children were kept indoors for a period of three weeks, and the subsequent disinfection, were but partially successful. In addition to the measures already named, after the first visit to each case of Measles, a letter was sent to the head teacher of the school attended by the child, stating the length of time during which the latter must remain at home; and the head teachers of the senior departments in each school were instructed not to admit to school any other children from the same house during the three weeks of infection. It is only right to state that these instructions have been loyally carried out by the teachers of the town, though the full benefit of this important measure has not been secured, owiiig to our being ignorant of about 66 per cent, of the cases. The infants' department of eleven schools were closed in consequence of the severe incidence of Measles on these schools. I could not however satisfy myself that this measure was productive of much good. Owing to the meagre character of the information received and the delay in its reception, the disease had obtained a complete hold on each school before closure was effected. Several Sunday Schools were also kept closed at my tequest. No hospital isolation was attempted during the recent epidemic of Measles, the available accommodation at the Sanatorium being in use for scarlet fever, &c. Summary of other Measures practicable for Measles.—The essential preliminary to any attempt to combat this highly infectious disease is to add it to the list of diseases already compulsorily notifiable under the Infectious Diseases (Notification) Act. With such notification, removal to the hospital or isolation at home, prevention of attendance of children from the infected house at school, occasional closure of schools, and disinfection after each case of the disease could be efficiently and com- pletely carried out. Cost of Notification of Measles.—Assuming that there were 3,770 cases of Measles in Brighton last year, then if a fee of 2s. 6d. were paid for each case notified, the total cost during 1892 would have been £471, as compared with £65 for all other notified diseases during the same year. The sum of £471 is, however a very extravagant estimate even for a year of such maximum prevalence of Measles as 1892. (a) For in the first place, if we may judge from the facts for the month of December (for which alone I have the information), 46 per cent, of the cases of Measles were unattended by any doctor, and the onus of notifying in such cases would fall on the householder, who does not receive any fee for discharging this public duty. (b) In the next j^lace, even of those cases attended by doctors, if we may judge again by the month of December, one half are attended by parochial or dispensary medical officers, to whom a fee of only one shilling is payable. Thus the amount actually payable during 1892 would probably not have been more than £120. If we give the maximum amount as £200, we have, I believe, an excessive estimate of the possible cost of notification of Measles during the worst epidemic years. During 1891 the amount payable for the notification of Measles (calculated on the above excessive basis) would have been £46, and the payment of this sum and the measures which would have followed the receipt of the notification certificates would probably have prevented the necessity for a considerable proportion of the estimated amount (£200) for 1892. If, however, by an expenditure of £200, or even of £471, a considerable proportion of the 117 deaths occurring last year from Measles in Brighton could have been averted, there would, I believe, be not the slightest hesitation on your part in extending compulsory notification to Measles. Is there then sufficient reason to hope for this to justify the making of this experiment ?