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returning children had a discharge from eyes or nose, and it is
possible infection may have been carried in this way; but I
was unable to obtain any conclusive evidence on the point. In
90 cases direct personal contact with previous cases has been
traced as the source of infection.
In March, the Metropolitan Asylums Board began to send
discharge notices to each Borough Council notifying the discharge
of the patient from hospital, and the system is now in regular
working for Diphtheria, Typhoid Fever, and Scarlet Fever.
Each case on return is visited, and it is hoped by this means
to prevent the occurrence of "return cases" of infection. Ten
cases of Scarlet Fever were returned to their houses, in which
complete recovery did not appear to have occurred. Nasal
discharge was present in four cases, sore throat in two, ear
discharge in three, and peeling of skin in one case. In six
cases of Diphtheria sequela; were also present. By the arrangement
of the Metropolitan Asylums Board it may be possible in
the future to trace the occurrence of " return " infection.
MEASLES.
As this is not a notifiable disease we can only gauge its prevalence
and degree of severity by means of the death returns and
school returns. Including both intra and extra-parochial returns
there were 69 deaths attributed to Measles during the year,
giving a death-rate of 0.68 per 1,000. The London death-rate
for Measles for 1903 was 0.44 per 1,000, there being 2,046 deaths
from that cause as against 2,360 in 1902. It is probable that
these figures do not fully indicate the destruction of life
due to Measles, for this disease is often complicated with bronchitis
or other respiratory disease, and hence some deaths due to
Measles are entered in the returns as due to bronchitis, &c.
In 1903 the secondary causes of death in the 69 cases were:—
pneumonia 42, bronchitis 21, miscellaneous 6. This gives 63 out
of 69 (or 91 per cent.) deaths due to lung complication.
Measles and Whooping Cough—both of which are looked upon