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94.7 per cent. The deaths above five years of age from measles in London are less than 150 a
year. The number of cases occurring below and above five years of age cannot be stated, but the
fatality is no doubt much greater at the lower ages.
Medical officers of health have frequently commented in their reports on the neglect of
parents to recognise the infectious nature of measles, and to take such precautions as are possible
to limit the spread of the disease. The County Council has now, with the consent of the Local
Government Board, extended to measles certain provisions of the Public Health (London) Act,
the principal of which, section 68, prohibits the exposure in a public place, without proper precautions,
of any person suffering from a dangerous infectious disease, and the transmission,
without proper precautions of infected articles. The other provisions are, section 60, which gives
power to sanitary authorities to require the cleansing and disinfection of infected premises, and
the disinfection or destruction of infected articles, and contains other provisions as to compensation
and shelter during disinfection; section 61 enables sanitary authorities to require infected
bedding, clothing, etc., to be delivered up to them for disinfection, and requires them to pay
compensation for any unnecessary damage; section 62 prohibits the casting of infectious rubbish
into ashpits without previous disinfection; section 63 prohibits persons from knowingly letting
houses who make false statements as to infectious disease; section 65 provides for a penalty on
persons ceasing to occupy houses without disinfection or notice to owner, or making false answer;
section 69 prohibits infected persons from carrying on any occupation in such a manner as to be
likely to spread disease; section 70 prohibits the conveyance of infected persons in public
conveyances; section 72 prohibits, in certain cases, the retention of the body of a person who has
died of any dangerous infectious disease; section 73 requires that, in certain cases, the body of
a person who has died in hospital of any dangerous infectious disease shall be removed only for
burial; section 74 prohibits, without previous notice to the owner or driver, the use of a public
conveyance for carrying the body of a person who has died of any dangerous infectious disease,
and requires the disinfection of the conveyance, if so used.
In another direction effort might be made to reduce the mortality from this disease. Pulmonary
complications are those which most frequently cause death in persons suffering from
measles. Dr. Harris notes that of 114 deaths in Islington from measles in 1902 the "secondary
causes of death" were pneumonia in 70 instances and bronchitis in 20 instances. Again, in
Bermondsey, Dr. Brown records 154 deaths from measles in that year, and of these the "secondary
causes of death" were broncho-pneumonia in 110 cases and bronchitis in 22 cases. The need of
careful nursing and of warm, well-ventilated rooms for such cases is obvious. In the homes of
the very poor the opportunities for the care of sick children are often wholly inadequate, and
the want of proper nursing must militate strongly against the prospect of recovery. The provision
of a sick nurse, and, in certain cases, the removal of the sick to a hospital, appear to be well
worth trial on a limited scale, with a view to gaining experience of their value in reducing the
fatality of cases of the disease in which there is risk of a fatal termination.
Scarlet Fever.
The cases of scarlet fever notified in the administrative county of London during 1902
(53 weeks) numbered 18,252, as compared with 18,381 in 1901. The number of deaths registered
from this cause in 1902 was 560, as compared with 584 in 1901.
The London rates in 1902 and preceding periods are shown in the following table—

The death-rate in each year since 1858 in relation to the mean death-rate of the period
1859-1902 will be seen on reference to diagram IX. The monthly case-rate and case-mortality
in each of the years 1891-1902 in relation to the mean of the whole period is shown in
diagram XI.
It will be seen from the following table that in the period 1892-1901 the London scarlet
fever death-rate was exceeded by the death-rates of Manchester, Liverpool, Nottingham,
Bradford, Salford, and Leicester, and in 1902 was lower than that of any of the undermentioned
towns except Leeds, Nottingham, Hull, and Leicester.
(1) See footnote (1) page 12.
*The Infectious Disease (Notification) Act came into force in 1889.