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whooping cough.
The reduced incidence of fatality was by no means equal in the sex-age groups, those at
ages 3-4 and 4-5 being notably higher. (See below.)

Note :—index Numbers could not be calculated where " ? is shown, as no deaths were recorded at those ages
during 1909-13.
The fatalities recorded in the Wards are set out below, as they support the view that
the apparent high prevalence of measles during 1914-18 was largely a matter of improved
records.

Hospital Isolation.—During the five years 319 patients (3'0 per cent, of all cases)
received institutional treatment, 130 in hospitals of the Metropolitan Asylums Board and 189
in the Infirmary. The fatality among the former (20 deaths) was equal to 15*4 per cent,
and that among the latter (42 deaths), 22'2. The patients included in this category are
"selected," i.e., those who are either seriously ill or in unsatisfactory homes, and higher
fatality is, therefore, to be expected.
Home Nursing.—In 1917 a contract was made with the Paddington and St. Marylebone
District Nursing Association, under which the Association agreed to nurse patients referred
to the Association by the Department. During 1917, 411 cases were so referred, and in
1918, 85. Among those patients there were 34 deaths in 1917 and 5 in 1918, the fatalities
being 8'2 and 5'8 per cent, respectively.
Mortality.—The total number of deaths recorded during 1914-18 was 204, as compared
with 252 during the preceding five years, the annual averages for the two periods being 53
and 50 respectively. The annual averages for the two sexes were—
Males
Females
Annual Averages.
1909-13 1914-18
Index Number.
24
26
30
23
121
89
showing that the incidence of death during the second period was greater among males
and less among females. During 1909-13 29.3 per cent. of the deaths occurred in institutions,
the proportion during 1914-18 rising to 31.7—an increase of 8 per cent.
Whooping Cough.—Although this disease is not scheduled for notification 2,479 cases
were reported to (mainly bv Form 84) or discovered by the Department during the period
1914-18. In the previous five years the cases totalled 2,732. The annual averages were—
for 1909-13, 546, and for 1914-18, 496. The annual numbers are given in Table III.,
Appendix.
The total for 1914-18 was 9 per cent, less than that for 1909-13, the same reduction
being observed in the total for males and females (all ages). The Index Numbers for the
sex-age groups used for this disease, with five exceptions, show a reduced prevalence. (See
below).