View report page

70
5.—Whether measles infection can be conveyed by carrier cases is not
known—that is, by children convalescent from the disease, or who
have been in contact, and who have not suffered from the disease—
possibly not, but it is probable that very mild and unobserved
cases spread the infection.
Dr. E. W. Goodall (" Manual of Infectious Diseases," p. 148,) says that the
contagion is not so persistent as that of some other infections diseases, but there
is reason to believe that the infection may be harboured in fomites and conveyed
by third persons. Second attacks are uncommon, they have been
estimated to occur in from 2 to 5 per cent, of cases, but the mistaking of the
rash of other complaints, such as German measles, erythema, &c., for that of
measles may invalidate the statement by a parent that a child has already had
measles. This error of statement is also a weak point in the system of admitting
to infant departments of schools, children mid (?) to have already had
measles. Few children escape the disease, but it is probable that it is less
dangerous to life the later it is delayed towards the second teething' about the
O «.
seventh year.
Mortality.—The death rate from measles of children under five years of age
per 1000 living under five years of age exceeds the death rate of scarlet fever
and diphtheria combined under that age. The Registrar-General's Annual
Reports show that the annual mortality from measles in the two decennia
(1881-90 and 1891-1900) after the decennium (1871-80), in which the
Elementary Education Act came into force, was about the same as the annual
mortality in the two decennia (1851-60 and 1861-70) preceding the advent of
that Act in England and Wales as a whole, but that in London there was an
increase during the two later decennia (18rtl-90 and 1891-1900). (See Table I
appended hereto). The Annual Reports of the Medical Officer of Health of
the Administrative County of London emphasise this increase during the
two later decennia, when calculated upon the number of children living at ages
0-5 instead of upon the number of persons living at all ages. (See Annual
Report of Medical Officer of Health of the London County Council for 1908,
second table under Measles.; Whether thiswas due to greater fatality or greater
prevalence it is not possible to ascertain in the absence of general notification of
the disease. Diphtheria increased enormously in mortality during those two
later decennia, but scarlet fever enormously decreased, due, no doubt, to the
larger number of cases removed to hospital, and to the fewer carrier cases that
scarlet fever appears to beget as compared with diphtheria. In the present
decennium the Annual Reports of the Medical Officer of Health of the County
of London show a pronounced fall in the mortality from measles, the reason
for which will appear later on.
Fatality. — It is only possible to ascertain the fatality of measles in places
where the disease has been compulsorily notifiable. Sir Henry Littlejohn
showed that during ten years compulsory notification of measles in Edinburgh,
from 1880-89, the annual fatality varied from 5-9 per cent, of cases to 1"5 per
cent., and averaged 3.1 per cent. At Aberdeen, where the disease was also
notifiable, Dr. G. N. Wilson showed (Public Health, November, 1905) that
from 1883 to 1902 it was epidemic every two or three years, that every third
epidcmic was the worst, and that the annual average mortality per 1000 living
was 0.43, and the fatality per 100 cases was 1.9.