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that it would be wise to make provision to secure the removal
of the sufferers to hospital, compulsorily if necessary, when
the home surroundings are of such a nature as to militate
against recovery. For there can be no doubt that with insanitary
conditions—want of space, of pure air, of proper
food and nursing—the disease does assume a virulent
(" suppressed ") type, and that pulmonary and other complications
frequently ensue, and are the immediate cause of
the fatal issue. This is proved by the fact that death from
measles is rare in the families of the well-to-do, whilst it is
common in the families of the poor, and just in proportion as the
sanitary and general home surroundings are defective and
unwholesome. But even in these classes the average casemortality
of measles is low as compared with scarlet fever.
The deaths, indeed, are numerous, but the cases, when the
disease is epidemic, are multitudinous. The same remark
applies to another infantile disease—whooping-cough—the
deaths from which in London in the first four weeks of 1892
were no fewer than 64-4, as against 301 from measles, 48 from
scarlet fever, and 29 from enteric fever. But at present no
suggestion has been made that this highly infectious malady,
from which, as from measles, nearly all children suffer, should be
added to the list of notifiable diseases. It may be added
that the annual average numberof deathsin London,inthe past
ten years, from each of the "seven principal diseases of the
zymotic class," was small-pox 327, measles 2,478, scarlet
fever 1,176, diphtheria 1117, whooping-cough 2865, "fever"
795 (including enteric fever 708), and diarrhoea 2930.
It would not be right to close these observations without
stating that, notwithstanding the lack of benefit hitherto,
Dr. Harvey Littlejohn is entirely in favour of keeping
measles on th& list of notifiable diseases. But then he is of
opinion that if the early cases were removed to hospital,
epidemics would be prevented—an optimistic view which
it is difficult to share. He admits that at Edinburgh "no