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notifiable caused 8,585 deaths; and when it is borne in mind that
attacks of this disease are not infrequently followed by interference
with development, the lighting up of latent tuberculosis, deafness,
and other serious disturbances, it is obvious that the mortality from
Measles is by no means a measure of the mischief which the disease
produces. The death-rate due to Measles cannot be measured in
terms of the deaths directly attributed to the disease. It is like
Influenza in that respect; being a disease which is indirectly responsible
for many deaths from Bronchitis, Pneumonia, etc. In Stoke
Newington the measureable part of the death-rate from Measles is
alone equal to the death-rates from Scarlet Fever, Diphtheria, and
Enteric f ever combined. This excessive death-rate is due to the
ignorance, neglect, and poverty of the poorer section of the
community.
Although over the country as a whole the crude mortality from
Measles and Whooping Cough shows a diminution in recent years, yet
when the deaths are calculated as a rate per thousand births there is
shown an increase in the Measles rate and a very small diminution
in the case of the Whooping Cough rate. This circumstance is due
to the difficulty of controlling these diseases. Notification is costly
and furnishes unsatisfactory results, owing to the doctor being called
in too late or not at all, and measures of advice, assistance, and
isolation are rendered very difficult owing to the fact that the
epidemics are so explosive in their origin that it is impossible for the
existing staff to deal with the large number of cases which suddenly
occur.
The bringing together of children under 5 in school class-rooms
plays a great part in the spread of the disease amongst that section of
the population in which Measles is especially fatal, by determining a
high attack-rate within an age-period in which the children are least
able to meet it. It would be a great gain if much of the attack-rate
could be postponed to a later age-period; and, in my opinion, the most
effectual step that could be taken to reduce the mortality rate from
Measles would be the exclusion of all children under 5 years of age
from the infant departments of elementary schools.