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In the distribution of measles mortality in London throughout the year 1903 the highest
death-rate obtained in Poplar (0.95) and the lowest in Hampstead (0.09). The measles deathrates
in London in the four quarters of the year were as follows—First quarter, 0.58; second
quarter, 0.66; third quarter, 0.21; and fourth quarter, 0.33 per 1,000 living.
The following table shows the number of deaths from measles at several age periods in
each of the metropolitan boroughs. For the purposes of this table deaths occurring in public
institutions belonging to London have been distributed to the sanitary areas in which the deceased
had previously resided (see footnote (1) page 7).

The year 1903 was, as judged by mortality, a year of comparatively low measles prevalence.
As stated in the last annual report, the order of the London County Council extending to
measles certain sections of the Public Health Act came into force on the 1st of April, 1903.
Measles is thus made subject to the law relating to the prevention of infectious disease, except
the requirement of notification. It is probable that the Council's order may be the cause of
more complete information being given by school teachers to medical officers of health
concerning children who are absent from school either because these children are
themselves suffering from measles or because they live in houses in which other persons are suffering
from this malady. The extent to which the information thus obtained fell short of completeness
as to occurrences of measles among children attending elementary schools during the year 1903
evidently differed much in the several districts. Dr. Reginald Dudfield expresses the opinion
that, so far as Paddington is concerned, it is believed that nearly all such cases were reported
when they occurred during term time. During the holidays, however, the chief source of information,
that of the school, was necessarily wanting. On the other hand, Dr. Bond states that,
apart from information derived from the registrars of deaths, he was only informed of cases in six
houses in Holborn, although measles was prevalent, and in no case did he receive information
from the schools. To what extent it is possible, under existing conditions, to limit the spread of
measles cannot vet be stated, but it is interesting to note that there is evidence in a number
of reports that the new powers for dealing with measles are regarded by medical officers of health
with satisfaction, although this opinion is not unanimous. There is, however, much recognition of
the value of these powers as an educational influence in teaching parents not only that measles
is a dangerous infectious disease, but that they should make efforts to prevent children suffering
from measles from being brought in contact with other children. The extension of the powers
of the Public Health Act to measles has in some instances led the medical officer of health to
urge the notification of measles. The question whether the spread of measles through school
attendance can be best limited by closure of schools, or by excluding children from affected houses,
is being studied by Dr. Kerr, the medical officer of the late School Board, and by Dr. Davies, the
medical officer of health of "Woolwich, precise information being obtained as to the number of
children in the Woolwich schools who have previously had measles, and the number who are still
liable to attack. Account will be found in Dr. Kerr's report for the year 1903, of the steps which
are being taken in this matter. Dr. Kerr expresses the opinion that it may reasonably be expected
that much may be done to postpone attacks in children to a later age.