HH62/2/RENFRE/55

Transcription

[Page] 54

auxiliary agency. The first step towards any efficient attempt at the
extirpation of measles is the compulsory notification of the disease;
without this, any attempt at its control is foredoomed to failure.
The next step, especially when the disease 'breaks out' in a poorer
class community, is to post bills plentifully over the district reminding
householders that they, too, as well as the medical men, are responsi-
ble, under the Notification Act, for the notification of cases occurring
in their households - this for the purpose of including cases with
respect to which no medical man had been called in. I have found
a most valuable auxiliary, here, in the village schoolmaster, to whom I
have forwarded posters, which I have asked him to display in the
school-room, and to the contents of which I have asked him to direct
the attention of the children, who shall be invited to bear the intima-
tion to their parents. Simultaneously, every effort must be made
to obtain the removal of the first cases to hospital, and especially the
first cases occurring in houses where there are no other children.
Under ordinary circumstances it will be found that these measures
do not suffice to prevent the spread of the disease. The main danger
in the case of measles arises in consequence of the fact that children
in the premonitory and undiagnosable, but highly infective, stage of
the disease are apt to be allowed to attend school, and thus it comes
that schools so often become the means of spreading the disease. In
view of this circumstance it becomes the duty of the medical officer
of health carefully to observe the progress of events - and it is here
that compulsory notification becomes indispensable - and if the dis-
ease is found to be spreading in a village beyond the two or three
families first attacked, to take immediate steps for closing the school.
There is no more delicate or difficult duty appertaining to his office
than that of deciding the point at which the school should be closed -
the medical officer of health has to resist the influence of the panic
which is apt to arise in connection with the slightest outbreak of
measles in a village community, he has to be careful not to interfere
rashly or unnecessarily with the educational machinery of the place,
and he must, above all, endeavour to avoid the 'too late' policy which
has generally characterised the resort to school-closure in the past.
He is somewhat hampered in Scotland, as compared with England,
by the circumstance that neither he, nor the Local Authority as a
body, have power to compel the closure of schools; he can only
advise, and throw the responsibility of inaction upon the educational
authorities. I believe, however, that no difficulty will arise in Ren-

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frewshire in respect of this matter. I have no difficulty in declaring
that, except under extraordinary circumstances, school-closure is not
justifiable in dealing with any other disease than measles, but I am
bound, as the result of a somewhat large experience, to say that
school-closure is the most efficacious means of dealing with an out-
break of measles, especially in the case of village schools, which are
attended by a considerable proportion of children who are not liable
to come into intimate contact elsewhere. One of the most interesting
characteristics of a measles outbreak is the occurrence of cases in
crops; often the school-register, too late, reveals the fact that twelve
or thirteen days before, a child has been at chool on the day before
the rash in his case was recognised, or even on the morning of the
day on which it appeared. Sunday-schools should, of course, be
closed simultaneously with the day-schools. For the rest, as close a
surveillance as possible must be maintained over the infected area, in
order to check the carelessness of the people, who consider measles
but a light thing, and who are apt to indulge in sympathetic gossip
in infected houses. All the time, of course, the necessary measures
of disinfection must be attended to.
Scarlet Fever, while never attaining the proportion of an epide-
mic during the year, was exceptionally prevalent in the eastern
central portion of the county in the early winter months. In dealing
with this excessive prevalence I was a good deal hampered in respect
of hospital accommodation, although I was fortunately able to
arrange matters so that only in three or four cases were we unable to
secure hospital accommodation where necessary. When it became
evident that there was likely to be considerable pressure upon our
accommodation, the Cowglen Hospital Committee authorised the
complete furnishing of the hospital, and the devotion of all the wards
to scarlet fever purposes; and the District Committee gave me a
free hand to dispose of any fever cases which might arise as I might
be able. Such enteric fever cases as we were bound to deal with I
proposed to send into Paisley Hospital. Soon, however, our legiti-
mate accommodation there was exhausted, but I continued to send
cases in, with the kind consent of the Paisley Local Authority, leav-
ing terms to be subsequently arranged. There came a time, however,
when the accommodation at the Paisley Hospital was no more than
sufficient for the requirements of the burgh, plus our four cases, and
I had to make arrangements with the Committee of the Johnstone
Hospital for the reception of three scarlet fever patients there. The