In all England and Wales during fully half-a-century of registration, measles has fluctuated somewhat from year to year but has not experienced a notable decline among the causes of infantile mortality (see the table at p. 614). In the decennial period 1871-80, its annual average death-rate was 377 per million living; in the next decennium it rose to 441, the previously high rates of scarlatina having fallen greatly. Among the highest rates for the ten years 1871-80, were those of Plymouth, 1·13 per 1000, East Stonehouse 1·79, and Devonport 1·19 (owing to a great epidemic in 1879-80), Exeter, 0·82, Liverpool ·91, Bedwelty (Tredegar and Aberystruth collieries) 0·88, Wigan 0·74, Whitehaven 0·71, Alverstoke 0·81. In the most recent period there have been some very high death-rates; thus at Jarrow the annual rate, which was only ·27 per 1000 from 1871 to 1880, rose in the nine years 1881 to 1889 to an annual average of ·94, having been made up almost wholly by great epidemics every other year—in 1883 (2·9), 1885 (2·4), 1887 (1·4), and 1889 (·9)[1230]. In the year 1888, an epidemic at Stoke-on-Trent, Hanley, &c. with 342 deaths, made a rate of 2·8 for the year; in Wolstanton, Burslem, &c., 221 deaths were equivalent to a rate of 2·6.
The latest reports of the Registrar-General have traced a progression of the epidemic of measles from county to county or from district to district in successive years, such as was remarked, both for smallpox and measles, by some of the 18th century epidemiologists in England, Scotland and Ireland.
Thus in 1890, measles was epidemic in Cheshire, South Lancashire and North Staffordshire; in 1891 it ceased in these, but became epidemic in North Lancashire, South Staffordshire and the West Riding; in 1892 it ceased in its last-mentioned area, and became epidemic in Warwickshire, Leicestershire, Derbyshire, the East and North Ridings, Westmoreland and Durham. During the same three years a similar progression or cycle was observable (on looking over the tables) in the South-west of England. The epidemic year of measles in Devonshire was 1889. It ceased there, and became epidemic in 1890 in Cornwall on the one side and in Somerset on the other, sparing Dorset. In 1891 it ceased to be epidemic in those parts of Cornwall and Somerset which it occupied in 1890, and became prevalent in the extreme west of Cornwall, in parts of Somerset, in Wiltshire and in Gloucestershire. In 1892 it ceased in all the last-mentioned excepting Gloucestershire, and became epidemic in Dorset, where there had been no severe prevalence of measles since 1888[1231].
Measles has no such decided preference for a season of the year as scarlatina and enteric fever have for autumn or infantile diarrhoea has for summer. But it often happens that most deaths are recorded from May to July, owing, doubtless, to the greater number of attacks in summer and not to any excessive fatality of that season. In London and the great industrial towns the deaths are spread somewhat uniformly over the year; or, in the language of statisticians, the maxima do not rise far above the mean of the year. In a tabulation of the weekly deaths in London from 1845 to 1874[1232], it appears that they touch a higher point in mid-winter (Nov.-Jan.) than in summer, a fact which may be readily accounted for by the injurious effects of the London air in winter upon a disease which is largely a trouble of the respiratory organs. In the great industrial populations of Lancashire, which resemble London in their high death-rate from measles, the rise of the deaths in mid-winter is almost the same as the summer increase[1233].
Most of the deaths from measles fall at present upon the ages from six months to three years, just as they did when the deaths were comparatively few, as at Manchester from 1768 to 1774. Deaths of adults, which were not altogether rare in the first great epidemic of modern times in 1808, are seldom heard of at present, for the same reason that adult deaths used to be uncommon in smallpox, namely, that the disease is passed by almost everyone in infancy or childhood. Although the deaths from measles sometimes reach large totals—in London during the spring of 1894 they were in some weeks as high as one hundred and fifty—yet it is the common experience of practitioners that a strong or healthy child rarely dies of measles, that the fatalities occur among the infants of weakly constitution, and especially in the numerous families of the working class in the most populous centres of mining, manufactures and shipping.
To bring these various characteristics of measles together in a concrete instance, I shall give briefly the facts of a recent epidemic in a town in Scotland of some twelve thousand inhabitants. There had been only five deaths from measles for two years. There had not been a case of smallpox for at least ten years. The measles epidemic, when its triennial opportunity came, reached a height in July, on a certain day of which month there were seven or eight burials from measles or its direct sequelae. Nearly all the children in the place who had not been through the measles in the corresponding epidemics of 1889 or 1887 suffered from it on this occasion, excepting the class of very young infants. The deaths in the whole epidemic numbered about fifty, which would not all be registered, however, as from measles. Yet this high mortality was not due to any unusual malignancy of the disease, but to the feeble stamina of a certain number of infants, or to the indifferent housing and tending of the poorer class. One did not hear of a death in the well-to-do families (probably there was none), although they had their full share of attacks. The frequency of the burials for a short time, and the effects of the epidemic on the mortality from first to last, must have been very nearly the same as in an epidemic of smallpox a century before, when the population was only a third or fourth part as large. But in the period when smallpox was in the ascendant, having few rivals among the infective causes of death in childhood, the general conditions of health in this town were altogether different. One or two specimens of the thatched huts of the poorer class had been left standing into the era of photography, so that we could compare past with present, in externals at least; also, of the houses of the richer class some still remained, perhaps turned into tenement-houses, with small windows, low doorways, and crow steps on their gables; and it was on record by the parish minister at the end of the 18th century, that within the memory of that generation there had been peat stacks and dunghills before the doors on the High Street of the burgh.
CHAPTER VI.
WHOOPING-COUGH.