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25
1920
sibility of controlling the spread of measles, but even the desirability
of doing so, were it possible. These persons regard all efforts at
control to result at best only in a short postponement of the
epidemic, and this postponement means a future bigger epidemic.
It may be mentioned that these are the views of Medical
Officers of Schools (not School Medical Officers).
Very few Medical Officers of Health will admit that some
amount of control is not possible, and they certainly will not
admit that very little is gained by attempting to control the spread
of measles. Even if the Medical Officer of Health fails with one
method, he must devise another, and not fold his hands because
he has failed.
The different views held by Medical Officers of Schools
and Medical Officers of Health may be partially explained by the
fact that the subject is viewed from a different angle, and sometimes
it is an advantage for the same person to hold the dual post of
School Medical Officer and Medical Officer of Health. The School
Medical Officer is concerned chiefly with the spread of the disease
in schools, and he is apt to measure his success or his failure by
the number of cases which occur. The Medical Officer of Health
is apt to base his view of success or failure on the number of deaths
which may result, and it is possible that under certain conditions
the number of cases which occur may be high, but the number
of deaths may be comparatively low, though as a general rule
the bigger the epidemic the higher the fatality.
It is well known that the main stress of measles falls upon
the child population, and in particular upon children between the
ages of 1 and 3 years. Ninety per cent. of the total deaths from
measles occur among children under 5 years, and nearly one-half
of the total deaths from the disease occur in the second year.
In a report to the Local Government Board the importance of
postponing an epidemic, even for a short time, was emphasised.
It was pointed out that a short postponement would carry a certain
number of children over the most susceptible period, and thus a
certain number of lives would be saved.
The case mortality at the age period 5-10 years has been
found to be only one-ninth of that in the third year of life. In
the fourth year of life the case mortality is less than one half that
in the third year of life.
In a discussion which took place at a meeting of the Medical
Officers of Schools Association, it was argued that a postponement
of the attack for more than six months could not be obtained,
and such a postponement was not worth while. Against the
slight postponement of attack is to be placed the fact that when