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27
920
conditions it is probably better to let the outbreak run its course
in the summer months rather than postpone its appearance until
the late autumn.
The percentage mortality of those attacked is difficult
to ascertain. Of course, it varies according to the age of the
patient, and under present conditions the action of sanitary
authorities, and more especially school authorities, will not alter
much the age incidence. The case mortality is probably in the
neighbourhood of 4 per cent. The point I wish to emphasise is
that this case mortality is much higher in a winter epidemic than
in a summer one, and every effort should be made to postpone,
if possible, a winter epidemic into a summer one.
The figures for Acton are too small to be of much use,
but they are significant, and probably an index of those throughout
the kingdom.
The last occasion on which, we experienced a winter epidemic
was in 1917. At that time compulsory notification was in force,
and 1,485 cases were notified and 39 deaths occurred.
In 1920, 950 cases were reported and 9 deaths occurred.
The most notable difference between the two epidemics was, that
the 1917 epidemic occurred in the winter and the 1920 occurred
in the late spring and summer.
Opinions differ as to the term of the postponement of an
epidemic. Most authorities now admit that a certain amount of
postponement of attacks can be brought about by a class closure
in a school, or by the closure of a department, provided that closure
took place before any secondary cases occurred or, as it was
expressed, before the occurrence of the first crop. In some instances,
it is possible to postpone an epidemic after the occurrence
of the first crop.
One of the objections to the postponement of an epidemic
is that a postponement means a bigger epidemic at a later period,
and it is a common experience that under ordinary conditions
the bigger the epidemic the higher the case fatality. It is claimed
that the symptoms are more severe if the infection is massive.
There is very little ground for this obection. The postponement
cannot be sufficiently delaved to modify the dimensions of the
epidemic. Moreover, when the postponement of an epidemic
can be successfully achieved, it is found that this takes place around
the school holidays, and the infection is rendered less massive.
If we take the 1920 epidemic as an example, we find that the
disease made its appearance in two of the schools before the Easter
holidays. These two departments were closed for a fortnight
before the Easter holidays and re-opened after the Easter vacation.