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32
The increased mortality from measles commences in 1889
and continued with few intermissions to 1913. There was then a
sudden drop which continued until 1924. There was a slight rise
in that year and although, compared with the period 1889-1913,
there has been a vast improvement we have not succeeded in attaining
the high standard reached in the decennium 1914-1923.
Various explanations have been given for this behaviour of
measles.
The most obvious explanation of the phenomenon is that
the varying fatality of the disease depends upon the virulence of
the organism or virus which causes measles. As the causative agent
has not been isolated this theory cannot be proved or controverted.
From a long experience of the disease, and in the last ten years, this
experience has included treatment of cases in hospital, I am inclined
to doubt this supposition. The initial symptoms in those cases
which were removed to hospital in 1934 in an early stage were severe
in almost every instance ; a temperature ranging from 103 to 105
degrees was usual and continued for several days. The rash was
intense, general and profuse. The initial symptoms did not differ
materially from those observed in the beginning of this century,
and there is not safe ground for the assertion that the virulence of
the causative agent has varied.
The alternative theory to an increasing or diminishing virulence
of the germ has to do with the improved resistance of the
child. It is unlikely from the history of measles that the improvement
has been secured by an increasing immunity on the part of
the children. It has been previously stated that in the older children
a certain amount of immunity has been established, but this
does not apply to the children in the second and third years of life,
amongst whom the majority of deaths occur.
It has been suggested that the increased attention paid to
infant welfare has been the means of increasing the resistance to
infectious disease or at any rate has enabled the child to escape the
complications associated with these diseases, and especially those
of measles. It is well known that the special attention paid to infant
welfare has been instrumental not only to reduce the infantile
mortality or mortality in infants under twelve months old, but has
been almost as successful in reducing the mortality amongst older
children,—in those between 1 and 5 years of age. It is sometimes
assumed that our efforts to reduce infantile mortality have left us
with a legacy of weaklings at later ages. But this is far from the
truth. The conditions which formerly killed a large number
• ufants, scarred and maimed many of those who survived beyond