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generally allowed to run its course without medical treatment,
properly so-called, and therefore, very many cases would
escape notification. It is true that the Act requires a "dangerous
infectious disease" to be reported by the head of the
family, but notification otherwise than by the medical man is
of the rarest, and it would be difficult to enforce. Measles becomes
epidemic about every second or third year in this parish;
it rages for a few weeks; its victims are numerous; and then,
for a time, only sporadic cases occur, the fatality being
relatively trifling. (See Table V. Appendix). But during
epidemic prevalence, measles is truly a "dangerons infectious
disease and taking one year with another, is the cause of a
greater mortality than scarlet fever, or even than diphtheria.*
In this parish in 1897, there were only 33 deaths from this
cause, whilst in 1896 there had been 173 deaths, of which 160
were registered in 24 weeks, including 45 in one period of four
weeks. Having regard to the percentage mortality of measles,
this number of deaths (160) indicates an immense number of
cases, probably 5,000, as compared with 1,780 cases of all the
notifiable diseases recorded in the same year. To deal with
such a mass of cases—if they did get notified—in so short a
period as half-a-year, and without action mere notification is
useless, would be a task of great difficulty. And what could
we do? I have always held to the view that without hospital
accommodation for the bad cases which occur in the crowded
and unhealthy homes of the poor, where, owing to complications
induced by insanitary conditions, the disease so often
proves fatal, no substantial benefit would accrue from notification.
There is no such accommodation, nor is there likely to
be; and, therefore, I think notification would be of little if any
avail, as a means for reducing the fatality of measles. The
disease is exceedingly infectious, and once in a tenemented
house, or a house let in lodgings, and swarming with children,
*The corrected annual average number of deaths in London from measles, in
the ten years 1889-98, was 2,841; from scarlet fever 955 ; from diphtheria 2,225,