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1920
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closure occurs all knowledge of secondary cases is lost, and it is
not until the school re-opens that the extent to which measles has
spread in the interval can be ascertained.
While in those schools which remain open absentees can be
visited, and skilled help given, in cases where the school is closed
the only knowledge that comes to hand in the interval is in the
death returns.
It is admitted that all children over 6 months of age, with
a few rare exceptions, are exceedingly susceptible to measles.
Although no complete explanation has been furnished, the low
proportion of deaths among infants under 6 months of age is an
interesting feature in measles. Whether the exemption is due to
a natural immunity or to the comparative isolation of "cradle
life," the evidence is not conclusive. In an enquiry into the medical
history of 14,000 children in one district, 47 per cent. of those
between 5 and 6 years of age had suffered from measles, whereas
of those from 10 to 15 years of age 90 per cent. had had the disease.
Similar inquiries have been made in other districts, and the
figures bear out the contention that the disease is so universal
in this country, few children escape it.
On the face of it, it seems that very little benefit can accrue
from the postponement of an epidemic.
But there are other factors which govern, not so much
the extent of an epidemic as its fatality.
It is a general experience that an epidemic is not so fatal
in the warm months of the year as it is in the colder months.
When we consider the cause of deaths from measles, this
phenomenon is easily explainable.
In the Registrar-General's Annual Report for 1911, the
causes of death in measles are given of the 13,128 deaths from
measles in that year. 1,066 were stated to have died from measles
(unqualified), 6,449 from broncho-pneumonia complicatory measles,
1,670 from pneumonia, and 1,109 from bronchitis. Over 90 per
cent. of the deaths from measles were due to complications, and the
most serious complications were due to respiratory diseases. The
prevention of these respiratory complications is far more difficult
in the winter months than it is in the summer months. If an outbreak
makes its appearance in the early part of the year, it is
undoubtedly an advantage to postpone, if possible, its epidemic
appearance until the summer months. If, on the other hand,
measles makes its appearance in the early summer, it is doubtful
if any advantage can accrue from its postponement. Under present