CHAPTER XV

MEASLES

BEFORE

EFORE the time of Sydenham (1685) measles and scarlet fever were not, as a rule, recognised as distinct diseases and both of these eruptive fevers were commonly confounded with smallpox. Indeed it not unfrequently occurs even at the present day that cases of smallpox are diagnosed as measles at the outset of the attack; but the development of the characteristic eruption of smallpox soon makes it evident that a serious mistake has been made. The period of incubation in measles is from ten to twelve days, and the eruption usually appears on the third day after the initial symptoms are developed. These consist of fever and catarrhal symptoms, attended with cough and a watery discharge from the congested mucous membrane of the eyes and nose.

Measles, like scarlet fever, is a disease which has not been materially influenced by modern sanitary measures. The sanitary statistics of England and

age

Wales show an increased mortality from this disease during the decade ending in 1890, over the previous ten years (2.57 per 1000 deaths under five years of in 1871-80 and 3.13 in 1881-90.) In the United States the total number of deaths from measles reported during the census year 1900 was 12,866. The number of deaths in 1000 from all causes was 12.9 while in 1890 the proportion was 11.1, showing a decided increase in this country also. More deaths occur in proportion to the population in cities (18.2 per 100,000) than in the country (9.9 per 100,000). The greatest mortality occurs among infants less than a year old (152.8 per 100,000) and among young children. After the age of five the mortality rate is greatly reduced (under five years 106.5; from five to fourteen. years 7.4). The death-rate among the coloured population was somewhat greater than among native whites. "The greatest proportions of deaths from measles occurred in the South-west Central region (51.7), the South Mississippi River belt (40.7), and the Southern Interior plateau (22.7); and the least in the Pacific Coast region (2.1), the Ohio River belt (6.3), and the Prairie region (6.5)" (Census Reports, 1900). The mortality from measles is to a large extent due to pulmonary complications, which are especially liable to occur in young children. The influence of external conditions in giving rise to these fatal complications

(broncho-pneumonia, diphtheria) is shown by the fact that the greatest mortality occurs during the months of February, March, April, and May, and the least during the summer and autumn months, also by the very low mortality of the Pacific Coast region.

The combined influence of an unfavourable climate and density of population is shown by the statistics. relating to the State of Rhode Island, which has the highest death-rate from this disease of any of the registration States (47.6). The lowest rate in the registration States was in Vermont (6.1).

Patients having measles may communicate the disease from the very outset of the attack and it is probable that the germ is present in the abundant secretion from the bronchial and nasal mucous membranes, as well as in the desquamated epithelium from the surface of the body after the eruption has developed. When convalesence has been established, if the patient's body and clothing have been disinfected he can no longer communicate the disease. The period during which isolation should be insisted upon, to prevent the extension of the disease, is about three weeks from the date of the first appearance of the eruption. The infectious material is not so tenacious of vitality as in smallpox and scarlet fever and the disease is not so likely to be conveyed by means of infected clothing and other articles exposed in the

sick-room, if an interval of two or three weeks has elapsed since infection. This fact, however, should not lead to a neglect of the usual measures of disinfection heretofore recommended (see p. 220 and p. 171). Free ventilation of the sick-room, after thorough scrubbing of surfaces with hot water and soap will, as a rule, ensure its disinfection. But it will be prudent not to allow susceptible children to enter such a room for at least fourteen days.

The following directions, published by the Board of Health of the city of Glasgow, set forth very forcibly the importance of preventing the spread of measles and the fact that isolation of the sick must be relied upon as the principal measure of prevention:

"Measles is a dangerous disease, one of the most dangerous with which a child under five years of age can be attacked. It is especially apt to be fatal to teething children. It tends to kill by producing inflammation of the lungs. It prepares the way for consumption. It tends to maim by producing inflammation of the eyes and ears.

"In Glasgow, during the last five years, measles has caused three deaths for every one which has been caused by scarlet fever; only one infectious disease has been more destructive to life, viz.: whooping-cough. Measles has carried off more than four times as many persons as enteric fever (typhoid).

"It is therefore a great mistake to look upon measles as a trifling disease.

"The older a child is the less likely is it to catch measles; and if it does, the less likely is it to die.

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If every child could be protected from measles until it had

passed its fifth year, the mortality from measles would be enormously decreased.

"It is therefore a great mistake—because, as a rule, children sooner or later have measles-to say 'The sooner the better,' and to take no means to protect them, or even deliberately to expose them to infection.

"It is wrong for mothers with children in arms to go into houses where measles exists.

"Every child with measles ought at once to be put to bed and kept warm. The mildest cases may be made serious by a chill. Measles is for this reason most dangerous in winter and spring.

"A case of measles continues infectious for at least three weeks after the appearance of the rash. During that time separation from the healthy ought to be secured either by removal of the sick to hospital or by isolation at home.

"Isolation means not merely a separate room for the sick, but the withdrawal of apparently healthy children from school (day and Sunday) and the exclusion of strange children from the house. "The isolation, as far as possible, from other children of all children belonging to the same family is more necessary in the case of measles than of any other infectious disease, because of this peculiarity-for days before the rash comes out, the child is highly infectious.

"School teachers, especially, ought to be familiar with the appearance of children in this stage of measles.

"The eyes are watery, glistening, and sensitive to light; there is a ringing cough, sneezing, and running from the nose, with flushed face; in short, all the signs of a bad cold in the head.

"No child showing these symptoms ought to be allowed to go to school.

"Any child observed at school with these symptoms ought to be sent home at once. Such children are to be looked for more particularly in the Infant Department.

"Sanitary Office,

"Montrose Street, Glasgow,

"January, 1897."

"DR. J. B. Russell.