Measles

“ Measles as a disease derives its chief importance from the risk, by no means slight, of certain complications which are apt to arise during its course, more especially inflammatory affections of the respiratory organs. These are most liable to occur in the colder seasons of the year and in very young and delicate children. It has been already stated that irritation of the respiratory passages is one of the symptoms characteristic of measles, but that this subsides with the decline of the eruption. ”

“ A great many scientists have described germs which they believe to be the causal agents, but up to date these have not been positively proven as the cause of measles. We do, however, know that the infection of measles is found in the secretions from the nose and throat during the first stages of the disease; therefore persons suffering with measles should not be allowed to come in contact with well persons until the period of fever has well passed. ”

“ Every now and then epidemics arise from the extension of the disease among those members of a community who have not been in some measure protected by a previous attack. There are few diseases so contagious as measles, and its rapid spread in epidemic outbreaks is no doubt due to the well-ascertained fact that contagion is most potent in the earlier stages, even before its real nature has been evinced by the characteristic appearances on the skin. ”

“ If the disease is measles, one may expect a general epidemic, since its power of direct contagion is nearly equal to scarlet fever, although the fatality is much less. It is unfortunate that so little pains are taken to prevent the spread of this disease and fortunate that, except in the case of very young children, the effect of the illness is only a temporary inconvenience. Curiously, however, if measles attacks savage tribes where it has been before unknown, the severity of the disease is very great. ”

“ MORBID ANATOMY.—The normal rash of measles is not to be observed on the dead body, and the only lesions of the skin to be noted are those resulting from extravasation of blood into that tissue. Examination of the skin removed during life from a patient with measles reveals the following anatomical changes, according to Morris.35 In the earliest stages are found usually slight hyperæmia around the orifice of a sebaceous follicle, with slight swelling from effusion of plasma. ”

“ Measles may, however, occur in a very malignant form, in which the symptoms throughout are of urgent character, the rash but feebly developed, and of dark purple hue, while there is great prostration, accompanied with intense catarrh of the respiratory or gastro-intestinal mucous membrane. Such cases are rare, occurring mostly in circumstances of bad hygiene, both as regards the individual and his surroundings. On the other hand, cases of measles are often of so mild a form throughout that the patient can scarcely be persuaded to submit to treatment. ”

“ They perhaps prove so fatal merely by having the start of other diseases. The measles, the chincough, the croup, the scarlet fever, and perhaps many others, would have proved equally fatal had they occurred first.” The principle is true to this extent, that a certain proportion of weakly infants, or children of poor stamina, will succumb to almost any disease—if not to smallpox, then to measles, and if not to measles directly, then to the sequelae of measles. ”

“ Measles, he says, is a disease mainly of young children (infantes) , and is apt to run through all that are under one roof. It begins with a rigor, followed by heats and chills during the first day. On the second day there is fever, with intense malaise, thirst, loss of appetite, white tongue (not actually dry) , slight cough, heaviness of the head and eyes, and constant drowsiness. In most cases a humour distils from the nose and eyes, the effusion or suffusion of tears being the most certain sign of sickening for measles, more certain indeed than the exanthem. ”

“ When you look at the hot, angry-looking, swollen skin of the little victim of measles, the weeping eyes and running nose, and remember that this same sort of process is either going on or is likely to occur all over his entire lining, so to speak, from lungs to bowels, you can easily grasp how important it is to keep him absolutely at rest and protected from every possible risk in the way of chill, over-exertion, or injudicious feeding, until the whole process has completely subsided and been forgotten. ”

“ The great point to remember in measles is, not to give up the treatment with the apparent subsidence of the disease, as the after-consequences of measles are too often more serious, and to be more dreaded, than the measles themselves. To guard against this danger, and thoroughly purify the system, after the subsidence of all the symptoms of the disease, a corrective course of medicine, and a regimen of exercise, should be adopted for some weeks after the cure of the disease. ”

“ But measles is an infection peculiarly apt to leave mischief behind. The bronchial catarrh, which is an integral part of the malady, and is often the cause of death in the second stage of the attack, may so affect weakly children that the respiratory organs are permanently damaged. Tuberculosis of the lungs is apt to follow measles. Some children, again, fall into mesenteric disease after measles, and die [Pg 660] tabid, the intestinal catarrh being as dangerous in one way as the bronchial is in another. Another large proportion of the subjects of measles take whooping-cough [1222] . ”

“ Measles is more fatal, especially among babies, than people realize. 2. Measles causes more diseases of the bones, ears, and eyes than any other communicable disease. 3. Measles is not dangerous if properly cared for, but when neglected, it causes much suffering and many deaths. ”

“ This difference appears more probable, as the small-pox I believe is always taken at a less distance from the diseased person than is necessary to acquire the measles. The contagion of the measles affects the membranes of the nostrils, and the secretion of tears in consequence, but never I suspect the stomach primarily, but always secondarily; whence the pulsation of the heart and arteries is always stronger than natural, so as to bear the lancet at any period of the disease. ”

“ We are accustomed to think of measles as a disease which, like meningitis, is disseminated throughout the civilized world, and which although constantly with us causes only sporadic cases. True epidemics of measles do occur, even when there is no gross change in the constitution of the population. We have discussed examples of this particularly in London. Flare-ups of measles prevalence are in fact so much the rule that in certain localities health officers anticipate a measles epidemic about once in two years. ”

“ Mayr's two cases of inoculation with nasal mucus showed no departure from this rule, but in the inoculations made by Katona with blood the prodromic symptoms made their appearance in seven days, the cutaneous lesions developing two, and at the most three, days afterward.
Minor epidemics of measles are said to occur every three to five years, more extensive and severe ones every seven or eight years. In the centres of population measles may be said to be endemic; in isolated regions the visitations of the disease may be widely separated. ”

“ Another of the great contributions to sanitary science in the last ten years has been the recognition of the part played by incipient cases and "carriers," apparently well persons, who are nevertheless discharging from nose and throat or bowels the virulent germs of disease. Measles, for example, is spread chiefly in its incipient stage, when the child has no other symptom than a slight running at the nose and goes to school or to a party, thinking it has only a cold in the head. ”

“ German measles, or rubella, is a distinct disease and has nothing to do with ordinary measles. It is extremely rare for a child to be much sick with it. There is usually a very extensive eruption which may cover the body, but few other symptoms. ”

“ No possible connection can be traced between the dissemination of the poison through the system by the action of the bacteria and the appearance of the skin, which is a minor factor in the disease. It may be worth while to repeat that the greatest danger from measles consists in the possibility of lung complications, and infinite care should be taken to keep the patient shielded from drafts and free from overexertion until recovery is complete. Like scarlet fever, the skin peels off, although not to the same extent, and the small particles are capable of transmitting the disease. ”

“ MEASLES.—Measles is a contagious disease, characterized by a preliminary stage of fever and catarrh of the eyes, nose, and throat, and followed by a general eruption on the skin. One attack practically protects a person from another, yet, on the other hand, second attacks occur with extreme rarity. It is more contagious than scarlet fever, and isolation of a patient in a house is of less service in preventing communication to other inmates, whereas in scarlet fever half the number of susceptible children may escape the disease through this precaution. ”

“ In fact, if you will study the records of this city, you will find that in two out of the last three years, measles has killed more people than scarlet fever, and whooping-cough more than either of them. ”

“ It is a distinct disease, and persons who have had both measles and scarlet fever are still susceptible to German measles. One attack of German measles usually protects the patient from another. Adults, who have not been previously attacked, are almost as liable to German measles as children, but [Pg 204] it is rare that infants acquire the disease. It is a very contagious disorder—but not so much so as true measles—and often occurs in widespread epidemics. ”

“ Furthermore measles has been known more than once to occur in extensive epidemic form, attacking large proportions of the population invaded. We know that there is an immunity to measles which is nearly absolute in those who have once acquired the disease. The epidemics have, therefore, occurred exclusively in those localities where the proportion of immune individuals was relatively small. According to Noah Webster in 1772 measles appeared in all parts of America and was accompanied by an unusually high mortality. In Charleston 800 or 900 children died of the disease. ”

“ In general, susceptibility is increased in the young; young animals can be successfully inoculated with diseases to which the adults of the species are immune, and certain human diseases, such as scarlet fever, measles and whooping cough, seem to be the prerogatives of the child. It must be remembered, however, that one attack of these diseases confers a strong and lasting immunity and children represent a raw material unprotected by previous disease. Where measles has been introduced into an island population for the first time, all ages seem equally susceptible. ”

“ If measles assume a malignant type, as it sometimes does among the nonrobust, it may be ushered in by convulsions, very high fever, and an excessive development of all the ordinary symptoms, or the rash when it appears, instead of being a good healthy-looking red, may be a bluish-black discoloration which looks like a recent bruise. Broncho-pneumonia, the most common and the most fatal of all the complications of measles, is very apt to occur. The cough is very painful, and death quickly relieves the sufferer. ”

“ J. S. Cameron, of Huddersfield, England, into the conditions of the dwelling as affecting recovery from measles, points to the conclusion that fresh air provided by a through draught tends to produce recovery when measles has attacked the family; while overcrowding, dirt, and structural or other insanitary conditions assist in bringing about a fatal result. ”

“ While smallpox did its work summarily, the full effects of measles were longer in being realized. This may in part explain the fact brought out by Watt, that while fewer children died under two years of age, measles being the dominant epidemic disease, there was an increase in the ratio of deaths from all causes between the years of two and five and from five to ten. ”

“ But now (1813) , when so few children have been through the smallpox, measles has become ten times more fatal to them, although it could hardly be more common than it used to be. Having found it necessary to assume that children in former times took smallpox before they took measles, nine-tenths of them taking both, he qualifies this in another passage: “Still, however, as the measles came round now and then, as a very general epidemic, they must occasionally have had the precedence, and it was perhaps chiefly among such patients that the disease proved fatal.” ”

“ There were reasons why measles used to have comparatively few victims, “and why, when they now prevail epidemically, they, as was the case with smallpox, are caught at an earlier age than other diseases in general and prove so very fatal: which happens not more from their priority in attack than from being in their nature what they were ever considered—a severe and dangerous disease. We are to recollect, however, that measles do not in general attack at so early an age as smallpox ”

“ Ha! here’s a powder I was going to send to the sick baby in yonder hovel, where the Irish ditcher lives. That baby has the scarlet fever. They say the measles are rife in the country too, and the varioloid, and the chicken-pox, and it’s bad for teething children. And after all, I suppose many of the poor little ones, after going through all this trouble snap off short; and so they had the measles, mumps, croup, scarlet-fever, chicken-pox, cholera-morbus, summer-complaint, and all else, in vain! Ah! there’s that twinge of the rheumatics in my right shoulder. ”