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Dr. Theodore Thompson found the fatality rate to be 6.1 per cent. of cases in
his Inquiry. (See Table II. appended hereto.)
Analysis shows that fatality varies according to periodic wave, epidemicity,
season, and age.
Influence of Season.—Years ago Buchan and Mitchell showed that in London,
from 1845-74, there were two maximum mortality curves, the larger maximum
extending through November, December, and three fourths of January, the
smaller maximum extending through May, June, and half of July. The more
recent diagrams in the Annual Report of the Medical Officer of Health of the
Administrative County of London show, from 1891 to 1898 (both years
included), that Dr. G. N. Wilson's experience in Aberdeen, from 1883 to 1902,
is also ti.at of London, namely, that measles is most prevalent during the cold
months of winter and spring. The London diagrams show a remarkable fall
during the present decennium in the maximum curve of mortality calculated
upon the basis of the mean of the years from 1891 to 1908, both inclusive,
with a tendency towards irregularity in the double curves of maximum
mortality during the year.
Influence of Aye.—The best summary of (lie effect of age upon the morbidity,
mortality, and fatality of measles is shown by Dr. Theodore Thompson's Table
of an urban district, 1892-94. (See Table II. (a) appended hereto.) This table
shows (1) that at 10 years of age and upwards the attack rate, the death
rate, and the fatality rate are negligible quantities; (2) that from 5 to
10 years the attack rate is 62 per 1,000 living, the death rate 0.7 per
1,000 living, and the fatality rate 11 per 1,000 attacked; and (3) that
under 5 years of age the attack rate is 137 per 1,000 living, the death
rate 11'6 per 1,000 living, and fatality rate 85 per 1,000 attacked—that is
to say, the fatality rate under 5 years of age is nearly eight-fold that of the
subsequent 5 years of age, the death rate is about sixteen-fold, and the attack
rate is over two-fold. The table further shows (a) that from 2 to 5 years of
age is the period of maximum attack rate; (b) that the maximum death rate
falls upon the second year of age, followed by the third year, and at some
distance by the fourth, which approximates to that of the first year of life; and
(c) that the incidence of fatality runs almost parallel with the ages of mortality,
with this exception, that during the first year of life the fatality is double
that during the fourth year, and approximates to the fatality of the third year.
This gives the impression that delay in the age of attack by measles diminishes
the risk of fatality analogous to the behaviour of scarlet fever.
That there appears to be a diminishing risk of attack with increasing age is
confirmed by the inquiries of the Medical Officer of Health of Willesden. lie
has kindly supplied me with Table II. (b) in the Appendix, and this shows that
the risk from 0-5 years of age is 70.7 per cent., as compared to 20.0 per cent.
from 10-15 years, and of 52.4 per cent. in the five years between those two
periods.
Influence of School. -It is shown in Table I. that during the last two decennia
the mortality from measles in London steadily increased. It is shown in
Tables III. and IV. that during the present decennium the mortality from
measles has steadily decreased in London. It is nlso shown in Table III.,