has remained practically the same. Surely no disease that causes 1 in every 100 deaths, or that rolls up an annual toll of between nine and ten thousand lives a year is insignificant or unimportant. A second point is found in the age distribution of the deaths in these two conditions. Nearly 80 per cent of the pertussis and over half of the measles deaths occur in infants. The older the child the lower the case fatality rate. The widespread impression among the laity that it is a good thing to have these common infections of childhood early and get them over with is erroneous. The longer they can be warded off, so much less the chance of fatal or damaging complications. The mortality of the first year of life is greater than the combined mortality of the rest of childhood. A part of this-birth accidentscongenital malformations, etc., may be termed fixed and is irreducible. But far the largest part is preventable to a certain extent. Somewhere between 5 and 10 per cent of the mortality which may be lessened is due to measles and pertussis. It is the hope of the committee for the pediatric section that the discussion tonight may arouse some interest in these ever present and much neglected diseases. MEASLES FROM THE STANDPOINT OF PREVENTION J. G. WILSON, M. D., Assistant Surgeon, U. S. Public Health Service, Ellis Island, New York Legislation Affecting Measles From the standpoint of prevention, notification and quarantine have not materially affected the incidence of measles epidemics. It may be possible to show that particular epidemics have been shortened by measures taken with that end in view, but if we review the situation as a whole, we will find that there is no constant relation existing between laws regulating the control of the disease and the rise and fall of epidemics. Frederic Crum tabulated the periodicity of measles outbreaks in 15 representative American cities for 13 years from 1900 to 1912 inclusive.* A study of his chart does not show any tendency whatever towards constant abatement either in the frequency of epidemics or their severity. Periodicity of Measles Epidemic in 15 representative American cities. Frederick Crum. Publication of Prudential Life Insurance Company. Realizing the failure of notification and quarantine to effectually prevent the spread of measles, there is a tendency on the part of some health officers to relax the enforcement of existing laws. As early notification and prompt isolation are from a theoretical standpoint entirely adequate to prevent epidemic measles, it would seem that some Effort in this way ought to be found to put the theory in practice. direction has so far been exerted in a diversity of ways. This is shown by an analysis of the various state laws and regulations dealing with the subject. Up to January 1, 1916, 38 states out of the 52 states and possessions of the United States required notification.† Some states require notification and placarding of the house only. Some require strict quarantine of all the members of the household, some of the patient only, and others of the patient and exposed persons. If we consider cities as well as states, we find that the duration of quarantine varies in different communities from five days to three weeks. From a consideration of these facts, it is evident that one of the first essentials is, not more drastic legislation, but a standardization of existing laws and regulations and their uniform extension to all communities. Given a uniform and sensible notification and isolation law in all the states, the question would then arise how best to apply that law. Applications of Notification and Isolation Regulations In the present state of our knowledge, prompt isolation of beginning cases is undoubtedly the only way in which epidemics may be nipped in the bud. As a rise in temperature is the first clinical symptom of the period of invasion, it follows that prompt isolation of all susceptible persons with fever, however slight, should prevent serious measles outbreaks. Experience at the Immigrant Station at Ellis Island, New York, in large measure substantiates this opinion. Children under 14 years of age have comprised 10 per cent of all arriving aliens at that port for the past ten years. There have never been wide variations from this average. Notwithstanding the practically constant distribution of susceptible persons the yearly incidence of the disease has varied greatly. For different reasons many immigrants are detained in large rooms and dormitories in the general administration building for periods varying from 24 hours to several days. Fresh measles virus is introduced by new arrivals at frequent intervals. As a consequence of this detention, nearly one-fourth of all our measles admissions have been derived from the waiting rooms and dormitories of the administration building. In an effort to abate as Those not requiring notification are: Colorado, Florida, Kansas, Missouri, New Jersey, New Mexico, North Carolina, Oklahoma, Porto Rico, Rhode Island, Tennessee, Texas, West Virginia and Wyoming.-Reprint No. 332 of Public Health Reports. far as possible this undesirable condition, Dr. L. L. Williams, the chief medical officer in 1915, instituted the plan of taking the temperature of all detained children twice every day. All children with temperature of over 99 degrees were promptly isolated. Following this procedure the proportion of cases of measles developing in the detention rooms droppd one half, and in 1916, the practice still being continued by Dr. J. C. Perry, the present chief medical officer, it did not rise above the former level of approximately 25 per cent. This failure to increase took place under conditions when a natural increase of cases from this source was to have been expected, because, during the year ending July 1, 1916, the proportion of measles cases to arriving immigrants, not only increased two-fold, but owing to difficulties in the way of deportation incident to the war, the average period of detention of all immigrants was immeasurably increased, thus making the detention rooms a veritable hot-bed for measles incubation. Solid line: Number of measles cases per 100,000 immigrants arriving at Ellis Island 1906 to 1916. Broken line: Number of persons under 14 years of age per 100,000 immigrants arriving at Ellis Island 1906 to 1916. Total Percentage of Prevention of Measles Outbreaks in Immigrants Detention Quarters by Daily Started in 1915. If so desirable an effect can be produced under such conditions of crowding and close association as prevail at Ellis Island, it would seem that similar procedures, introduced in the homes and schools at the |