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of death. The main incidence of death is on the second year,
while the incidence of attack is on the fourth, fifth and six
years. The fatality of Measles is therefore much higher in the
second year than in any of the succeeding years. It will thus
be seen how important it is to endeavour to lengthen the
interepidemic period. To secure this end many administrative
measures have been proposed. Among these, the question of
the exclusion of children under five years of age has been the
subject of investigation by a Departmental Committee of the
Education Department. Raising the age of attendance to
five years would diminish the spread of infection for a time,
but it must be recognised that in the southern portion of
Acton the exclusion of children under five must lead to the
establishment of Creches. The question of controlling infection
in Creches would have to be considered, as in poor
districts such institutions would certainly have to be introduced
for the care of young children whose mothers have to go out
to work. It is of interest to note in this connection that the
district of South Acton has been visited on two occasions with
an epidemic of Measles since the institution of the South
Acton Day Nursery and in no instance has the disease spread
amongst the children attending the Nursery. This immunity
may have been partly due to the size of the Creche, and very
large Day Nurseries may serve as foci of infection.
There is one significant difference between the two outbreaks
which occurred last year. In the first one, that is the
one that was controlled and in which only nine cases occurred,
we were fortunate in being notified of the first case at the time
of its occurrence. In the second, and more extensive outbreak,
the first notifications referred to the first "crop" and not to
the first "case."
The difficulty of obtaining information of the earliest
cases constitutes one of the chief obstacles in the control of
Measles. To overcome this difficulty the compulsory notification
of Measles has been tried in several places. Nowhere has