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primary cases notified was 1,497, including 382 cases of German
measles and 1,115 of meales.
As there were only 42 deaths from measles this makes a case
mortality of 3.7 per cent. on the first cases. If, however, we
assume that there was at least one more case in each house this
would make a case mortality of only 1.8 per cent., which figure,
I imagine, is much nearer the truth than the large one.
As regards inoculation, we know too little about the poison
of measles to be able to make an effective vaccine. General
hygiene is no doubt useful in helping to keep children from an
attack, but the disease is very amenable to proper nursing and
medical treatment. If one analyses the death returns it will be
found that death is rarely due to uncomplicated measles, but is
generally attributed to an intercurrent attack of pneumonia or
bronchitis, both of which complications would probably have been
prevented had the patient been put to bed on the first symptoms,
and properly nursed.
The prevention of measles is one of the hardy annuals of the
Public Health world. All sorts of devices such as isolation,
notification, disinfection, and school closure have been tried with
a view to preventing or limiting its spread, and have eventually
been given up, but while discussions on its prevention have been
numerous, I have heard little said in favour of allowing every
child to catch it, except occasionally among some benighted
mothers, who, when a case occurred in the family immediately
exposed the other members to infection with almost invariable
success.
At present the plan of modified notification mentioned above
holds the field and of those suggested it certainly seems the most
commonsense, for it aims not so much at preventing an attack
as warding off a fatal issue. This is often all our
aim in many infectious diseases, especially those
prevalent in childhood, for the question of the incapacity
produced by an attack is only important, where
adults are concerned. It is well known that many regiments
recruited from certain remote parts of the Empire suffered badly
from measles caused by the want of protection afforded by an
attack in childhood. We do not know the fatality of the attacks,
but clinical experience shows that the disease may be very