By Gisel Gutierrez
Measles, caused by the measles morbillivirus, was a very difficult disease to prevent in the late 19th and early 20th centuries. This virus was so contagious that it spread rapidly in areas with large crowded populations. This caused urban areas to have the most frequent outbreaks with the most devastating mortality rates. Until 1963, when John Enders and his colleagues developed a vaccine, measles was so common that people believed the disease was something every child had to go through. The report of the Medical Officer of Health for Acton mentioned how this belief caused many mothers to willingly expose the rest of the members of her family to the infection in order to get it over once and for all. Due to the lack of information and research they had on measles or even yet on all types of viruses, the preventive measures taken by the public health officials around London were not as effective as they could have been. The methods suggested were not always taken into consideration by the citizens or were announced too late. This resulted in failing to properly stop further spread of the infection, resulting in high mortality rates.
One of the measures suggested but not always enforced was to have schools shut down when around 30% of the school’s population was diagnosed or had symptoms. This resulted in constant outbreaks, sometimes even three times within six months causing a devastating decline in students towards the end of the school year. In another note, some schools like Maryon Park completely ignored the suggestion, continuing school regardless of how many of the students were sick. The schools that didn’t cancel classes argued that it was a complete waste of an effort. Their data suggested that the same number of students were infected in schools that closed as in schools that didn’t. They argued that by the time schools shut down classes, it was too late to prevent infection. The report of the Medical Officer of Health for London County Council of 1904 showed that there was not a significant difference in the number of cases reported to further advise the closing of schools. Instead, public health officials began strategizing other means to prevent the spread of measles before it reached schools. Some of those means were the educating and enforcement of proper hygiene in all schools.
The report of the Medical Officer of Health for Wimbledon stated that shutting down schools was not effective because it was too late due to the mother’s negligence and ignorance. Maternal care such as feeding, clothing and managing of infants played a major role in the mortality rate. Public health officials advised mothers to breastfeed, claiming that this would decrease the chances of an infant becoming infected and decrease the severity of the infection if the infant were to get infected. The Report on the sanitary condition of the Hackney District for the year 1899 also supported those ideas and measures, although it involved both parents, not just the mother. It listed the symptoms for both severe and ordinary cases. Preventive measures were to observe when children became fatigued, lacked appetite and looked poorly in order to care for them then before it progressed to the rash. It was known that the infection was extremely contagious before the rash even appeared, indicating that if there was any suspicion of that a child was sick, it was best to quarantine them in a well-ventilated warm room away from the rest of the household. It was advised that any discharge from the sick child was to be collected in a rag and immediately burned. Anything that the sick child came in contact with, such as clothing, bedding, towels and silverware was to be removed from their room and deeply washed with disinfectants way before someone else came in contact with it. Whoever was attending the child should always wash their hands after leaving the room. The Public Health Department was in charge of going to the houses where a child was recovering or if there was a death to properly dispose or clean any items the child touched or was near to. It was free of charge so anyone from the poorest family had this service available in order for their children to be allowed to return to school.
The public health officials distributed this type of information through the use of circulars. Circulars are now known as flyers or pamphlets. Officials hung them around common areas in the cities or passed them around hospitals. This was the easiest and most effective way to advertise proper protocol in order to prevent the further spread of measles. This method reached just about anyone that was able to read or had someone to read it to them. This allowed every citizen no matter their class to be informed.
London County Council 1919
E. Conis, “Measles and the Modern History of Vaccination” Public Health Rep. 2019 Mar/Apr; 134(2): 118-125.