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1880-85 the notifications were 14,418, the deaths 520, and the
case-mortality 3'8 per cent; whereas in the second six years,
1886-91, the notifications were 22,032, or 7,614 in excess; the
deaths 730, or 210 in excess, and the case-mortality 3.7 per
cent. or O.l per cent only below that in 1880-85. Some allowance
must, of course, be made in respect of number of notifications,
and of deaths, for increase of population—at the rate of
about 3,300 annually,—in the inter-censal period 1881-91; but
this does not affect the question of case-mortality. The fact
remains that the apparent benefit of notification in the shape of a
reduced percentage of mortality in the latter half of the ten years
period (1880-89) disappears when the figures are extended so
as to include the 12 years' period (1880-91).
Referring to the lower mortality in 1885-89, compared with
1880-84, Dr. Harvey Littlejohn, in a communication with which
he favoured me, observed, that "Epidemics of measles appear
to vary very much as regards severity; and in Edinburgh,
although the number of cases has risen during recent years, the
type of disease has been mild on the whole: the weather at
the time of the epidemic must also influence the mortality very
considerably, as nearly all the deaths are from chest complications."The
percentage of deaths to notifications in the 10
years was 3 1. The highest rate was 5'9, in 1880, when 3216
cases were notified, and the lowest 15, in 1881, when only
631 cases were notified. Apart from the increase in the gross
number of deaths, it is unsatisfactory to observe the large
increase in the number of cases notified in the second half of
the twelve years periods, 1880-91. This increase shows that
under the conditions prevailing at Edinburgh, notification has
not had the effect in respect of measles which it appears to
have had in respect of typhoid fever and scarlet fever, of largely
reducing the number of cases. The manner in which poor
people live in Edinburgh is not of the most favourable kind for
securing the full benefits of notification, so many persons living
in "Flats," and using the common staircase which facilitates the