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101
spread of infection. Moreover, little use comparatively is made
of the hospital for the isolation of the sick. In the four years
1886-89, out of 15,102 cases notified, only 824 were removed to
hospital. In 1890 the notified cases were 4,761, of which 274
only were removed. In 1891 the notifications were 2,169, the
removals 223. In 1890, the home-treated cases, it may be
mentioned, show a case-mortality of 5'06 per cent., that of the
hospital cases being 4"70 percent. The proportionate mortality
of home and hospital cases in 1891 was 3'22 and 1*34 percent.
Assuming that the more severe cases were removed, the
mortality in hospital compares favourably with the mortality
outside.
But, it may be asked, what use do the Edinburgh
authorities make of notification ? It appears that when a case
of measles is notified ,an inspector at once calls at the house
and gets the names of the children, and the schools attended
by them. At the same time he sees what means of isolation
there are; warns the parents about keeping the children at
home ; and tells them what precautions to use, and to send
to him when the house is ready for disinfection—if
disinfection be desired. In the poorest parts of the town,
where the cases are almost wholly treated by students from
the dispensaries, removal to hospital is always advised, and
as much pressure brought to bear as possible : not, it would
seem with over much success. In cases of a better class,
attended by a regular practitioner, removal to hospital is
suggested (by the inspector) where it is a first case in a
crowded tenement, and there is danger of the disease
spreading to the other families. In the Edinburgh houses,
built in "Flats," as many as twenty families may use one
common stair, so that the members of the various households
are continually coming in contact ;hence, under such
circumstances it becomes a most important matter to remove
the first case of any infectious disease. In the same way
endeavours are made to get the first case appearing in a