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25
The whole question of the control of measles is beset with difficulties; school closure and
the exclusion of susceptible children frequently fail to prevent the spread of the disease, whilst
the notifications sent by head teachers to the Public Health Department are, in large numbers of
cases, not received until the time for effective action is long past.
The best hope of reducing the heavy mortality from measles which occurs every year in Kensington
would appear to lie in the adoption of measures designed to postpone the age of attack, and in the
provision of hospital treatment for children whose home surroundings preclude the possibility of
adequate nursing. Since the end of the year 1910, hospital treatment has been provided by the
Metropolitan Asylums Board. During the year under consideration 102 children v\ith measles have
been taken into the Metropolitan Asylums Board Hospitals, but the opportunities of the Public Health
Department were limited during the epidemic period by the fact that admission was only available
for pauper patients through the Relieving Officer. On May 30th, 1911, eight weeks after the
epidemic was over the Local Government Board issued the Metropolitan Asylums (Measles) Order,
1911, which authorises the reception of non-pauper patients with measles on the recommendation
of the Medical Officer of Health for the district in which they live. In future years the provision
sanctioned by this Order should be of the greatest value. The age of attack could be postponed by
the rigid exclusion from school of children under 5 years of age. Since large numbers of deaths
occur each year as the direct result of attendance in the baby class the abolition of such classes
should be unceasingly advocated by Health Authorities until it has become an accomplished fact.
WHOOPING COUGH.
The deaths from whooping cough numbered 54; the number of cases brought to the notice
of the Public Health Department by the schools being 255. In the homes visited 83 addition d
cases were discovered ; the total number of cases dealt with by the Sanitary Inspectors being 338.
An advisory leaflet was left with the mother of each family visited. The largest number of cases
occurred in the Gloucester Grove School, where 35 children were attacked; the Fox School contributed
the next largest number, notifying 28 cases of whooping cough during the year.
Of the cases visited only 65 had received medical treatment. The excessive fatality of the
disease in young children was shown by the fact that 53 out of 54 deaths, or 98 per cent. of the
tctat number registered during the year, occurred in children under the age of 5 years. The
seasonal incidence of fatal attacks was greatest in the months of February and May, and least in
the last four months of the year when only one death occurred.
The measures to be adopted for reducing the death-rate from whooping cough are the same
as those already recommended in the case of measles. Cases of whooping cough are received in
the hospitals of the Metropolitan Asylums Board, but the provision made is limited to paupers,
that is to say to children who are recommended for admission by the District Medical Officers
of the Board of Guardians. During the year 66 Kensington patients were treated for whooping
cough in the Board's hospitals.
EPIDEMIC DIARRHœA.
During the year 184 deaths were registered as due to the group of diseases described by the
Registrar-General as Diarrhoea and Enteritis. This group includes a small number of deaths
which were not caused by the form of enteritis commonly known as epidemic diarrhoea, but for two
reasons the various types of diarrhoea will be treated together. The first reason is that an overwhelming
majority of the deaths from diarrhoea in years which include many weeks of unusually
hot weather are due to the epidemic type : the second is that the distinction made on death
certificates between the infective and non-infective forms of diarrhoea is in many cases arbitrary,
and therefore valueless.
The mortality at all ages was equivalent to a death-rate of 1.1 per 1,000 and at ages under one
year to 38 deaths per 1,000 births.
The seasonal incidence of fatal cases in four-weekly periods has already been given in the
Table on p. 24, which shows that up to June 17th no increase in mortality had occurred. On this
date the epidemic wave began to rise, and did not disappear until November 4th. The weekly
incidence of deaths is shown in the following Table, together with the temperature prevailing in
the weeks to which the death returns relate, and the figures are limited to the epidemic period.