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43
are received weeks, and, it has even been months, after the
absence of the children referred to. As it happens, the actual
figures for the year are not dissimilar, namely, 1,710 from the
head teachers and 2,285 notifications from medical practitioners.
Of course, the head teachers' returns relate only to children of
school age, whereas those of the medical practitioners relate to
persons of all ages. The weekly number of notifications received
in the first four months of the year were only 2, 3 or 4, figures
which rose to 15 and 13 in May and June. The absences from
school, however, over these months showed that whereas in
January the incidence of measles was low, there was a steady
rise in the succeeding months and the disease had become quite
widespread by the second quarter. In many large towns measles
exhibits a characteristic bi-annual beat. This is particularly
marked in London, and the extra-metropolitan areas in general
behave similarly, the high incidence occurring in the first months
of the even years, though the incidence will have started to rise
in the last months of the odd years. The 1940 epidemic, however,
failed to put in an appearance, and the number of cases which did
occur in this district in the earlier months of the year bore no
relation to what might have been anticipated. The weekly notification
rate of 30 in July was followed by a lighter incidence in
August and this, in turn, by a progressive increase in the next
three months when the weekly notification figures for September,
October, and November were 72, 119, and 152. This increased
incidence at what must be accepted as an unusual time of the year,
was not general. Although not being heavily attacked in July,
the district was, at that time, receiving over one-third of the
notification of all cases of measles which were being made in the
County of Middlesex. This, broadly, remained the position for
the next three months, though, by November, because of the
increased prevalence elsewhere in the County, in spite of the larger
number of notifications received in Harrow, the proportion had
fallen to one quarter and by December the proportion was only
one-fifth.
Measles in itself is not a disease of high fatality, but the high
rate of respiratory complications makes it a dread ailment. The
large number of patients who succumbed to the infection in the
milde; months of the year removed this number from those who
might have succumbed in the more severe weather when respiratory
complaints are the more likely to occur, and also lessened the
likelihood of an epidemic outbreak. To this extent the district
has been the favourite of fortune, even more so than its neighbours.
The number of fatal cases was only four.
In the case of measles and whooping-cough where notifications
have been received visits are not paid to the homes by the
health visitors as a routine practice. The medical practitioners