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resulted, it was with great reluctance determined to take no action. Notification
must in all cases be regarded merely as a preliminary to the taking of preventive
measures, such as isolation of the infected during the period of maximum
infectivity. In the case of measles it has been clearly demonstrated that the
disease is most highly infectious in the earliest stages, even before diagnosis is
possible and before notification could be made and isolation become possible.
This being so, practically always the damage due to spread of infection has
occurred before action for prevention can be taken. Isolation, as a matter of
fact, in any one case is rarely carried out, and is almost impossible to carry out,
before infection has been passed to other susceptible contacts. Further, with
regard to isolation it may be said that, cases of measles being so numerous, to
make provision for notified cases in the same proportion as for the other infectious
diseases would mean great increase in the existing isolation accommodation.
That measles is a disease neglected to a certain extent is undoubtedly true.
It is equally true that this neglect is not wilful. The great stumbling-block in
the way of progress in connection with its prevention is ignorance of its causation.
Till something more is known regarding it than the plain facts with which
practically everyone is acquainted, it seems doubtful if there will be much
reduction in the number of cases and of epidemics of measles.
Towards the end of the year arrangements were made by the Metropolitan
Asylums Board to isolate, through the Boards of Guardians, a certain number
of suitable cases in their hospitals. The experiment will be watched with great
interest and its effect upon the death rate carefully noted.
Whooping-cough.
Much that has been said with regard to measles, applies to this disease also.
Information with regard to cases is received in the same way.
Whooping-cough is most common and most fatal in childhood. The
number of deaths in 1910 (41), was nearly double that for 1909 (24) which was
exactly double the total (12) for 1908. The age period 1—5 is that in which
the majority of the deaths occur, the number for 1910 being 24 (58.5 per cent.)
The number of children under one who died of whooping-cough last year was
15, the largest number for several years. Of those who died aged less than one
year, 2 were under 3 months' old, 3 were more than 3, but less than 6 and 10
more than 6, but less than 12 months' old. As in the case of measles, therefore,
whooping-cough increases in fatality with age, the maximum fatality being
reached about the age of 5 years.
As death in the case of whooping-cough, again as in measles, usually results
from respiratory complications, chiefly pneumonia, the explanation of the
increasing liability to lung trouble is want of sufficient protection during the