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121
Seasonal Influence.
Measles is most prevalent during the cold weather of the
year. This is well shown by the diagrams in the Annual Report
of the Medical Officer of Health for the County of London.
There are, however, two maximal mortality curves in the year,
the larger maximum occurring in November and the smaller in
June..
Influence of Age.
This is one of the most important and significant points in
any inquiry into the history and causation of Measles. I have
shown that in Battersea during the decennium 1903-12, 777 or
95-2 per cent, of the deaths from Measles were of children under
5 years of age. In a Report to the Local Government Board on
Measles, it was stated :—
(1.) That Measles attacks chiefly children in the third, fourth,
and fifth years of life. (2.) That the greatest mortality from
Measles occurs in the second year of life, and (3) that Measles is
pre-eminently fatal in the second, third and first years of life.
At the age period 5-10 in actual outbreaks the fatality was found
to be only one-ninth of the fatality in the third year of life. In
the fifth year of life it is only one-seventh, and in the fourth year
of life it is less than one-half of that for the third year of life.
The influence therefore which age exercises as a factor1 in the
incidence and mortality of Measles is one which has a most
important bearing in relation to the administrative control of the
disease, as will be referred to further on in this Report.
Influence of School.
It is generally admitted that the channel by which Measles
is spread is through the Infants' Departments of the Public
Elementary Schools. In discussing the influence of age, it was
shown that the incidence of the disease is highest in the third,
fourth, and fifth years of life. The practice of sending children
to School under five years of age, the statutory period, is thus,
to a great extent, responsible for spreading Measles, bringing
together as it does, aggregations of a highly susceptible material
in rooms in which frequently the air-space and ventilation are
insufficient and defective. In a Report submitted by your
Medical Officer of Health to the Council in 1908, this question
was dealt with, from which the following extracts may be quoted.
" It can hardly be said that the attendance at School of children
under the age of 5 years can be productive of any real value from
the educational point of view. Up to this period, and later of its