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Assuming the case-mortality to be 4 per cent., the cases would have numbered 2,325: 2,150
in the first half-year and 175 in the second.
Of the notifiable diseases after which disinfection has been carried out hitherto, there were
in the same year 734 cases only: 403 in the first half-year, 331 in the second. But all cases of
small-pox, scarlet-fever, diphtheria, enteric-fever, etc., are notified; whilst of measles cases
no information is forthcoming in respect to the great majority.
The 93 deaths occurred, as already stated, in 92 houses, and I heard of 182 other houses in
which the disease was alleged to have occurred. For the bulk of information received in respect to
the non-fatal cases I am indebted to the head teachers of Board Schools acting under official
instructions. The cases in children attending school were 173: 63 other children were excluded on
account of disease in the family or the house, children not being permitted to attend school from an
infected house.
Assuming the accuracy of the reports and figures, we should have had to disinfect 274
houses (267 in four months—January to April—and 7 in the remaining eight months), whilst, on an
average of three cases to a house, about 500 houses would have gone without disinfection. It may
be anticipated that in the future, the publicity given to the Order will lead to the disclosure of a
larger proportion of infected houses.
How do the facts set out bear on the probable effects to be anticipated as a result of the
issue of the Order ?
Measles is infectious from the onset of illness. It takes about two weeks to incubate, and so
the first case in the family may recover before a second child falls ill.
It will be thought, naturally, that disinfection should be done on recovery of the first case, in
hope of preventing a second; but the probability is that a second child (and others if there be more
'than one susceptible) will have developed the disease at the date when disinfection would have
become possible after the first case.
It is always probable that the disease, once it has found admittance, will spread to all of the
families occupying a tenemented house; parents, as a rule, not being in dread of measles; indeed
they commonly prefer that all of their children should have the malady at one time, and so get the
trouble over.
The same feeling, or a sense of the inevitability of measles, often makes parents in the house
generally, indifferent to the risk of infection, especially if the first case should be of a benign
description. Not seldom, moreover, the disease spreads in a tenemented house whatever care may
be taken by the heads of families.
Theoretically, the proper course would be to disinfect after a first case—though it will
generally be ineffectual to prevent spread—and after the last case, when more than one occurs; but
then, the fire having gone out for want of fuel, it matters little whether disinfection be carried out
or not.
A question arose as to the extent to which disinfection should be carried out; whether of
infected rooms and contents only, or also by removal of infected articles to the disinfecting station ?
After due consideration of the matter, it was finally decided, as a tentative measure, to
disinfect infected articles in the room by spraying with formalin, and experience, so far, has justified
the propriety of the practice. But disinfection was not at all generally resorted to, either because
householders objected to it, or because, in many cases, the occurrence of the disease was not revealed.
The assumed number of cases of measles was 900, in an unknown number of families and houses,
the number of disinfections was 56 only.
It will be manifest, I think, from the foregoing observations, that if it should be deemed
imperative to enforce disinfection after measles, the disease must be made notifiable. Hitherto,
however, I have not seen reason for believing that any substantial gain, commensurate with the
expense (to say nothing of the trouble) that notification would entail, is likely to accrue therefrom.*
SCARLET FEVER.
The notifications of scarlet fever were 330, compared with 367, 475 and 372, in the three
preceding years successively; 237 in North Kensington and 91 in South Kensington. The deaths
were 14 (11 below the corrected decennial average); 11 and 3 in the Town and Brompton sub-districts
respectively. The case-mortality was 4·2 per cent. Ten of the deaths were of children under five
years of age, and 12 took place in hospitals to which 277 cases were removed. The deaths in the
three preceding years were 4, 15 and 21, respectively. The rate of mortality was 0·08 per 1,000 of
the population.
* The question of Notification of Measles was considered in the third monthly report, 1903, page 60.