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symptoms, so that suspicion of the true nature of the disease may
be lulled, but about the third or fourth day the distinguishing rash
appears, at first on the face but afterwards spreading to the whole
body. The rash remains out for two or three days but gradually
fades, and the skin desquamates. Frequently the rash leaves a
brownish stain, which persists for two or three weeks.
The poison of measles is given off by the breath and by the
secretions, particularly those of the nose. It may be conveyed by
a third person, or by clothing, carpets, &c. Usually the infective
matter is passed direct from child to child, but it is sometimes airborne,
especially in badly ventilated school rooms or hospital outpatient
rooms. There is no evidence of its having been conveyed
by water, milk or food, but the disease has been frequently inoculated,
and in such cases the incubation period is less than 10 days. The
actual contagium, or materies morbi, has never been isolated, and
its nature remains unknown. No distinguishing bacillus has been
found which complies with Koch's law.
The infection is freely given off during the preliminary febrile
stage, the patient meanwhile appearing to be suffering from an
ordinary cold; many authorities are of opinion that this stage of
the disease is the most infectious period, and if so, a sneezing child
sickening for measles is capable of distributing the infection within
a fairly large radius. The infective period continues so long as the
rash and bronchial symptoms persist, and to a less extent during
desquamation ; about three weeks is the average period.
The case mortality of this disease is stated by authorities to be
about five per cent., but as measles is not a notifiable disease, I have
no precise knowledge as to the number of children yearly attacked
in Bethnal Green. During the past 10 years the mortality has
averaged 116 per annum, a rate on the estimated population of
young children under five years of age of about seven per thousand
living.
Early in December the following circular-letter was received from
the London County Council and was referred to the Sanitary
Committee for discussion and report.