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Preventable Diseases of Children: Measles
MEASLES Measles is the most contagious eruptive disease of childhood. It is probably a germ disease, but the germ by which it is caused has not yet been identified. German measles -more properly Rotheln or Rubella -is not a form of measles nor is it a mild type of scarlet fever. It is a distinct disease. Black measlesthe malignant type of the diseaseis very fatal. The black color is due to hemorrhages in the skin.
Measles may occur at any time during the year, but is most prevalent in the fall and winter months.
Symptoms. The period of incubation is from ten to fourteen days after exposure. The symptoms for the first two or three days are very much like those of an ordinary cold in the head. The eyes become red and watery and are sensitive to light.
The nose is stopped up or there is a discharge from the nose, with sneezing. The throat is sore and there is a dry, hard, high-pitched cough. The tonsils may be swollen or red, headache, fever, loss of appetite, drowsiness and irritability are usually observed.
Occasionally the disease comes on suddenly with vomiting and high fever, but usually the fever is not very high. It may disappear on the second or third day with improvement of all the other symptoms. Then the temperature again rises and continues very high until the fourth day when the eruption appears. The disease is contagious from the outset of the earliest symptoms. Hence any one suffering from these symptoms should be isolated and kept under observation for three or four days, especially if measles is prevalent.
Children should be kept from both day and Sunday school.
The characteristic skin eruption appears on the fourth day on the face and neck and thence over the whole body as dull red blotches a little raised, and later running together.
It gives the skin a peculiar mottled appearance. Before this occurs one cannot be positive that the case is one of measles. But generally there is an eruption of some light red spots on the inside of the cheeks two or three days before the external eruption. If care is taken to be on the lookout for this symptom the nature of the disease may be determined early. The eruption lasts usually four or five days and disappears as the other symptoms improve. It is followed by a fine bran-like desquamation or peeling, which is usually complete in about a week.
Prognosis.-Measles is quite commonly regarded as a slight and trivial disorder. Hence parents not infrequently expose young children to this malady from the mistaken notion that they are certain to contract it some time and the sooner it is over the better. It is true that the disease is more severe in adult life.
But on the other hand it is a very fatal disease among young children.
It causes about three times as many deaths as smallpox and nearly as many as scarlet fever. Measles and whooping cough together cause nearly as many deaths as diphtheria. The mortality from measles is much higher than is generally supposed.
Ninety-five per cent of all deaths occur in children under five years of age, and far more deaths occur under than over two years of age. The death rate from measles in times of epidemic ranges from 4 per cent to 6 per cent and not infrequently exceeds that from scarlet fever. The danger from measles is chiefly due to complication with other diseases, such as whooping cough and bronchial pneumonia, or to after-effects, such as consumption, paralysis, meningitis, diseases of the skin and nervous disorders. Inflammation of the ear is a not infrequent complication of measles. This often leads to deafness or worse. Latent tuberculosis in a child often becomes active after an attack of measles. If a child "seems to have caught cold" after measles consult a doctor at once.
PREVENTABLE DISEASES OF CHILDREN Hence exposure to infection should be avoided and every case should receive skilled medical attention.
It Modes of Infection. -Measles is contagious from the beginning of the symptoms-usually three or four days before the eruption occurs. is during this first stage of the disease, when the symptoms can hardly be distinguished from those of an ordinary cold in the head, that direct infection is most often communicated. The disease is usually conveyed to others by direct exposure but may be conveyed by the discharges of the nose and throat and possibly from the fragments of skin thrown off from the surface of the body during peeling. Infection may be carried by the clothing of the patient, or those who come in contact with him, and by other objects. But the germs are not nearly so longlived as those of diphtheria and scarlet fever. Hence the danger from secondary infection is much less.
Mild cases may give the disease in its most malignant form and are equally as contagious.
Quarantine. - When measles is prevalent and especially if there is likelihood that exposure has occurred, children should be kept under close observation for ten days to two weeks and promptly isolated on the appearance of the first symptoms.
If red spots are not observed on the inside of the cheeks within two days, or if the eruption does not break out within four or five days after the first feverish symptoms, the case may be regarded as a simple cold in the head. But if there is any evidence of eruption, however mild, isolate the child in the sick room prepared as for typhoid fever and promptly summon a physician.
Practically everyone is susceptible to measles. One attack usually protects a person against others, but this rule is by no means invariable.
The course of the disease is usually more severe in adult life, hence in the management of the sick room observe all the usual sanitary precautions. room.
Quarantine.-Isolate all suspicious cases, especially during periods of epidemic. Placard the premises.
Keep all visitors out of the sick Protect, especially, children under five years of age and adults who have never had the disease.
The disease is communicable until the peeling is complete, which will be, as a rule, within three weeks from the onset of the malady.
The quarantine must be continued until the patient's temperature has been normal for forty-eight hours.