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Report of the Medical Officer (Education).
129
more than any other factor. Practically every child suffers measles sooner or later under the crowded
condition of life in English towns. The mortality varies with other factors which mostly reduce the
opportunity for personal contact; thus, the urban counties present higher mortality rates than rural
counties.
The social condition, which in the higher ranks means better care for children and also relative
isolation of young families, is such that probably the average age at which measles is contracted in the
working classes is under five, whilst in middle or upper-class children it will approximate to seven or
eight. The younger the family the higher the death rate is likely to be, and this as well as contact is
a partial explanation of rates in one, two or three roomed houses.

The disease depends on a contagium vivum, which has not been yet isolated. The infection does
not cling to fomites or persist out of the body, so that any special disinfection of things or places is
probably unnecessary.
It has been demonstrated in carefully regulated institutions that, like the other infectious
diseases, children with measles can be nursed in the same wards with other susceptible children without
the latter running serious risk of infection, if strict aseptic precautions are maintained.
The published returns of the City Hospital at Providence, U.S.A., show that in an isolation ward
with no other precaution in regard to prevention of spread of infection than attention to strict
surgical cleanliness, the following cases were treated between March 1st and December 31st, 1910 :—
Scarlet fever 38
Diphtheria 18
Measles 38
Other contagious diseases 71
Non-contagious diseases 25
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Dr. Chapin states: "In the treatment of all the contagious diseases contact infection is avoided
by strict asepsis, and air infection has been disregarded."
No case of cross infection occurred in the ten months, and only one case of measles and one case
of chicken pox developed among the 190 patients treated in this ward. The conveyance of the infection
is probably almost always direct, by particulate emanations in coughing and speaking, and the radius
of infection to be measured by a few feet. The adoption or discarding of general methods of disinfection
by municipal authorities has not in any way affected measles mortality at Aberdeen, New York,
Paris, Providence or other places where the case rates have been studied, and if demonstrated to be
useless general disinfection is costly and wasteful.
The sufferer from measles presents a latent period whilst the infection is multiplying in his body.
The length and fixedness of this period suggest the evolution of some particular life cycle of an organism.
After about the ninth day from exposure slight catarrhal changes appear about the mouth, nose and
eyes, and thenceforward the child is highly infective. On the twelfth to the fourteenth day the rash
has come out, then the infectivity rapidly diminishes. During recovery there is fine desquamation of
the skin. Infectivity is usually assumed to last till all signs of desquamation are over. It has probably
ceased before that, but the assumption of a month from the beginning of the illness is well over the
margin of safety.
Carriers, that is, cases infective themselves, but not suffering any malaise, have been looked
for in vain. These cases may play a leading part in the diffusion of scarlatina and diphtheria, but the
high proportion of children who actually suffer measles almost puts the question of carrier cases out of
the field.
The picture then of measles is of a disease very fatal during infancy, which every child suffers,
and which confers almost complete immunity from further attacks. Its prevalence at any time varies
according to the aggregation and proportion of children liable to be attacked, but also varies according
to quite unknown factors with race, country and year. It is usually introduced into households by
the children who go beyond the family circle, and who have hitherto escaped infection. Latent or
carrier cases and second attacks are so rare as to be negligible, so far as administration is concerned.
Years ago I was fortunate enough to be able to watch the spread of measles outbreaks in isolated
schools, and concluded that the outbreak if unrestrained ran through a school and exhausted itself in
three weeks, and that the apparent good effect of school closure was an entirely spurious result. The
only general method formerly used was to close a school when the attendance had fallen by 40 or 50
per cent. As there is an incubation period of nearly a fortnight, and as cases are infectious for four
or five days before ceasing attendance through indisposition, it was possible to reconstruct, from subse
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