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Measles (All Children’s Diseases)

Bryan Applications, M

A highly infectious fever, measles, morbilli or rubeola, is caused by a germ. The disease mostly affects children between the ages of six months and two years, but adults may suffer from it, and in severe degree. Epidemics appear to occur about every two years, and in temperate climes these reach a maximum in June and December.

The secretion of the eyes, nose, mouth and throat of a person suffering from measles contains the germs, which are therefore disseminated by breathing, and especially by coughing and sneezing, not to speak of more intimate contact. Should they reach the eyes, mouth or air-passages of a healthy person who is vulnerable to the disease, there is a period of incubation of from seven to fourteen days, usually about ten, and then symptoms resembling those of a common cold occur. The temperature may be 101° or 102° F. sometimes it is higher.

About two days later, small spots, with a white center and a pink margin, and known as Koplik’s spots (after the New York pediatrist, Henry Koplik) may be seen on the inside of the lips and cheeks, and reddish patches on the palate. On the second day also it is common for the temperature to drop.

From three to four days after the onset the rash appears. This consists of tiny fiat, dusky red or perhaps pink papules, which are grouped together to form patches, often of a crescentic shape. These appear first on the face and often on the neck and trunk, and may be very itchy. With their appearance the temperature again rises.

Meanwhile, the running of the eyes and nose and the cough have been going on unabated. Sometimes there is diarrhea. The rash usually begins to disappear in two days, and there may be a fine scaling, or desquamation. The temperature now falls rapidly. Often enough, however, some complication occurs. Severe bronchitis is a common one, and it may go onto the lung disorder called bronchopneumonia; or the patient may suffer from the other type of pneumonia, lobar pneumonia, or from pleurisy, and perhaps empyema. Increased rapidity in breathing, duskiness of the face, and a sharp pain in the side are some of the symptoms suggestive of chest complications.

The cough may become croupy and the breathing stridulous, showing that there is laryngitis. It must be borne in mind when such symptoms occur that they may be actually due to diphtheria, as this disease sometimes exists along with measles.

Earache may indicate an extension of catarrh to the middle ear, and not infrequently this is followed by suppuration and a discharge of the ear. Occasionally there is extension of infection within the skull, and meningitis.

Complications from intercurrent disease:

The catarrh of the eyes may be severe, with a copious discharge containing matter. In severe cases of measles there may be bleeding into the skin, the spots not disappearing when they are pressed by the finger, as they ordinarily do. Another disease which may coexist with measles is scarlet fever, and it is not uncommon for whooping-cough to follow an attack of measles, and conversely.

As regards the outlook in measles, it may be said that the younger the patient the greater the risk. Also, when measles has invaded a community which has previously been free from it, the mortality has been high. For example, it wrought havoc in the Faroe Islands (1846), where within six months of the first case of measles, more than three-fourths of all the inhabitants were attacked, and many died. Even more destructive was the first epidemic in the Fiji Islands (1875), due to absence of immunity.

A person suffering from measles should be isolated at once. The steps to be taken in this connection, as regards disinfection during the course the disease and after recovery, under the heading Infectious disease. The treatment is that of fever (q.v.) generally, while complications should be dealt with according to the instructions given under appropriate headings. It may be said, however, that the room should be kept at a temperature of about 65° F. and the air should be kept moist by means of an humidifier. At the same time a plentiful supply of fresh air by the window is also necessary,

Treatment of eyes and mouth:

A screen should be placed so as to prevent light falling directly on the eyes, as the patient often display marked intolerance to light, a condition described as, photophobia. If there is much discharge from the eyes, they should ba bathed frequently with warm boracic acid solution.

It is very important that the mouth should be kept clean, and to insure this, it should be washed out several times a day.

A patient should not be allowed out of bed until the temperature has been normal for a week, and the greatest pains must be taken to insure a good convalescence by means of fresh air, good food and, when required, tonics. It is necessary to protect against sudden changes of temperature. There is always a risk that tuberculosis of the lungs may be a legacy from an attack of measles. The patient should not be allowed to mix with others until at least two weeks after the disappearance of the rash, and only then if quite better.

Children who have been in contact with a person who has developed the symptoms of measles should not be allowed to return to school for sixteen days after the last exposure to infection.

Meanwhile a close watch should be kept on them. Even before the catarrhal symptoms of measles actually appear, it may be found that a child taking measles displays a reddening of the lining of the eyelids, and has a slight rise of temperature at night. Should such evidences be found, the child should be isolated at once. Blood serum from a person convalescing from measles, if injected into another person, will generally prevent the occurrence of the disease, and this procedure is sometimes practiced on young children for whom, as has been said above, the disease carries special risks. One attack of measles generally confers immunity for life, but second, third or more attacks do occur. These are, however, milder, as a rule, than the first attack. See: Cancrum oris.. Infectious disease..

Application and treatment:

Treat as infectious disease.