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116
Between December 5th and 10th, 9 other cases occurred
amongst children attending the same class as the November case
2 cases occurred in another class, and 1 each in two other classes
in the same department. These 13 cases were the first crop. Most
of the second crop fell during the Christmas holidays. 3 cases
occurred among children attending the Infants' department of
the Priory School. The date of onset was given as December 18th.
When the schools were re-opened after the Christmas holidays,
43 cases were reported from different classes in 3 Infant
departments, and in the following months all the schools were affected.
The epidemic was extensive, but compared with former
years, the fatality was light. In the first decade of this century.
Measles was one of the most formidable problems which we had
to face, and no other disease caused so much dislocation of school
administration. It caused more deaths than all the notifiable
diseases put together. In the four years 1906 to 1909, we had
125 deaths from Measles alone. It can thus easily be understood
how everything was tried to postpone or to control the course of
an epidemic. Among the measures adopted were the closure of
schools and departments for indefinite periods, and the exclusion
of all children from an infected family and house from school at
tendance. It can be imagined to what extent a Measles epidemic
in those days interfered with the educational machinery, and the
irritating part of the proceedings was that the measures adopted
were almost useless. A more intimate study of the epidemioloey
of Measles showed us the reason for the futility of the methods in
vogue, and gradually a change of procedure took place. At the
present time, school closure is hardly ever resorted to. The disease
is infectious from the appearance of the corvzal symptoms, and this
dates some daysbeforethe appearance of the rash. It is possible in
hospital to diagnose the disease before the appearance of the rash
and possibly before the disease is infectious. Koplik's spots make
their appearance on the inside of the cheek and mouth early in the
illness before the appearance of the rash, and when these are sought
in contacts an earlier diagnosis can be made and the sufferers isolated.
Such a diagnosis is not feasible in children attending school
in them the diagnosis is not made until the rash appears. Usually
the child attends school during the early stages before the appear
ance of the rash, and the mischief has been done, as the children
had attended school during the most infectious period and a numbers
of contacts would be incubating the disease when the school or
department was closed. When the schools were closed the contacts
who would develop Measles among the excluded scholars, would