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Thus out of 627 cases of measles, only 48 had been reported to have had measles before, or
7'6 per cent. If we take the outside view that all the second attacks were children wrongly
reported in the first instance, we have the error as 7'6 per cent, at the greatest. The probability is
that the error is much less, and this is borne out by the successful cases of individual exclusion, to
which reference will be made later.
The Question of Second Attacks.—Assuming that all the histories were correct, the second
attacks would work out at 7'6 per cent.; they are probably, as has been explained, less than this.
In the case of Union Street the child who undoubtedly set up the disease was reported to have
had measles before, and had been seen by a doctor, both before and upon this occasion; although
there is not the least doubt that she carried the infection into school, yet no rash was seen upon her
by the doctor or the mother; she had the coryza simply and got pneumonia because the complaint
was treated lightly and she was allowed to go out with inflamed bronchial passages. It is
possible, therefore, that a person who has once had an attack may suffer from a slighter attack
of true measles in which no rash appears; such a phenomenon is known in scarlatina and in
small-pox, and there is no reason why it should not occur in measles; however, the question
must remain open at present, but even if it does occur it must be so rare as to be negligible
as a factor.
Another case of interest in this connection is one which occurred at Conway-road on May 27th,
1904. Lilian L. was absent at the time a crop of measles was expected in the class. I visited
her and found she had a temperature, a cough, suffusion of the eyes, and Koplik's spots were
present in the mouth, yet no rash appeared; the mother watched carefully, and I visited on
several occasions, but no rash was to be seen. She was said to have had measles before. Another
child in the same class at the same time, Daisy H, (æt. 6), under precisely similar circumstances,
in addition to the same symptoms, had a very fleeting measles rash which might almost have been
passed by unnoticed; she also had had measles previously.
The Effect of Class Closure.—An examination and comparison of the results in the closing and
non-closing halves of "Woolwich, given in the above table, shows that the percentage of unprotected
cases attacked varied from 13 2 per cent, to 90 per cent, in schools where closure was resorted to at
the earliest opportunity, and from 22.5 per cent, to 62.6 per cent, in schools where no closure was
carried out. Amongst the former class, however, Timbercroft-road, with 81.5 per cent., and Deansfield-road,
with 90 per cent., are temporary buildings. Excluding these we still have Ancona-road
giving 41 per cent., "The Slade" 50 per cent., and Purrett-road 65 per cent, of cases—a range
higher than the average of the non-closing schools. In these schools, however, the actual first case
was missed, and closure only took place on the occurrence of the "first crop." In Earl-street and
Vicarage-road, where earlier knowledge was obtained, they suffered to quite as great a degree during
the year as in the average of non-closing schools, while at Conway-road, in which alone any striking
difference is met (only 13.2 per cent, suffering), every other condition combined to arrest the spread
and the very low proportion of susceptible cases in attendance (26 per cent, of the whole) diminishes