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Dangers of a Common Infections Disease
One of the most ordinary of infectious diseases, measles is also one of the most danerous, because of the complications which may ensue. In these pages the symptoms are detailed and the whole course of the disease and its treatment described, together with possible complications which may be avoided by care in the early stages.
Measles is an acute infectious disease which, although it may occur in isolated cases, commonly sweeps through a community in epidemic form. These epidemics usually happen at intervals of about two years and in England have been found to attain their maximum in June and December.
The disease may produce a heavy mortality amongst very young children, and do this in communities where it has never before occurred or not for a great number of years. During the period 1928-32 in London it has caused eight times as many deaths as scarlet fever and one-and-a-half times as many as diphtheria. Children between the ages of six months and the end of the fifth year are chiefly affected. Although it is not a common occurrence, adults may be attacked.
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Measles appears to be due to a microbo or to a virus not yet identified. The infection is conveyed in the secretions of the eyes, the throat and the nose of a person suffering from the disease, and to a much less extent by the skin if it is touched.
Symptoms of Infection.
The period of incubation, or the time which elapses between infection entering the body and the appearance of symptoms, varies from 7 to 14 days, the usual duration being probably 10 days. At the end of this time the child is seized with what seems to be a bad cold. He becomes feverish, the eyes and nose run, he sneezes and may have a cough. For a day or two prior to this, however, it is probably found that the red lining of the lower eyelid looks swollen and that the temperature rises in the evening. This is the time to isolate the patient, as, when the catarrhal symptoms above described have appecered, the child is already infectious.
On the second day of the disease the temperature often drops. Two days, or sometimes rather longer, after the onset, if the child's mouth is examined, two things may be seen. One is the measles rash on the palate in the form of dark red spots, and the other is what is known as Koplik's spots, minute bluish-white spots, surrounded by a pink zone, which occur on the inside of the cheek and on the inner surface of the lips.
The rash on the skin appears on the third or fourth day of the disease, first on the face, as a rule, then spreading to the neck and chest. It consists of slightly raised red areas in patches which often have a crescentic form. The rash may be very itchy. Occasionally a rash occurs consisting of dark red areas which do not disappear when pressed upon by the finger. At other times, and especially in hot weather, there may be minute blisters. The rash begins to disappear in about two days; often the skin comes off in fine flakes.
During these developments irritation of the air passages increases, the eyes showing this by intolerance of light and the air tubes by an increase of the cough and perhaps hoarseness.
Possible Complications
It should always be remembered that diphtheria may occur with measles and cause hoarseness and a croupy cough, so the doctor should be informed when such symptoms make their appearance. Scarlet fever may also be concurrent with measles in an individual. The most common serious complication of measles is broncho-pneumonia, the onset of which should be suspceted when the breathing becomes rapid and perhaps there is grunting. This complaint interferes with the aeration of the blood, and the child's lips and face assume a darker hue. In some cases bronchopneumonia is due to the super added activities of the tubercle bacillus, and there is always a risk that in other cases the damaged lung may become the seat of tuberculosis.
Another complication may be inflammation of the middle ear, giving rise to earache, and possibly later to a discharge of matter from the ear. A child suffering from measles often contracts whoopin-cough also, and vice versa.
Smokh   A day or two before the appearance of the rash on the skin in measles, small spots may be found on the inside of the lips and cheeks. These are known as Koplikís spots.
Treatment of Measles
Isolation is best accomplished in a room on the top floor of the house provided that it is large and airy and has a fireplace. The carpet should preferably be taken up and replaced by rugs, and superfluous furniture should be removed. The hangings should be light and washable. It is of the utmost importance that the room should be kept at an even temperature of about 65˚ F., and the air should be kept moist by the use of a bronchitis kettle (q.v.). Fresh air by way of the open window is essential throughout. Draughts can be prevented by the use of a screen, and something of this kind may also be used to keep light from falling directly on the eyes while these are sore.
The diet, during the feverish period, consists of lime water, strained soups, fruit juice drinks, and cereal foods. Cold water should be given freely to relieve thirst. Each day the patient should be sponged with warm water, care being taken to avoid undue exposure, and the mouth should be cleaned several times. For the latter purpose, a little glycerin of borax in water will serve, and this can also be used to spray the throat at the same time. If the skin is itchy the body may be covered with a dusting powder (q.v.).
If the cough is troublesome, a teaspoonful of Friar's balsam may be put into the bronchitis kettle, which is brought near to the patient's bed. A fomentation to the throat may also be useful. It will often, however, be necessary for the doctor to prescribe a simple cough mixture. Bronchitis and broncho-pneumonia call for the special treatment described under these headings. A high temperature of delirium should be met by sponging the body, one part at a time, with cold water after an enema is given. If the eyes are sore they should be washed with a lotion censisting of a saturated solution of boracic acid (q.v.) and hot water in equal parts.
Should the patient suffer from earache, warmth should be applied, and medical advice sought at once. If there is diarrhoea, milk should be stopped and arrowroot and warm water given instead. It will be necessary to peptonise the milk if it is not well digested. When the temperature drops, eggs lightly cooked, custards and milk puddings should be added to the diet, and later steamed fish minced chicken and other light foods.
Precautions During Convalescence
The patient should be kept in bed for a week after the temperature becomes normal, and a week later can go out, if the weather is warm. For a considerable time after measles, as far as possible, the patient should be protected from sudden or great changes of temperature.
The child should not be over-clothed, but the outer clothing should be as warm as the temperature of the air demands. Cod-liver oil and malt, soups, and gelatin help to further a return to normal vigour.
A patient who has suffered from measles should not be allowed to mix with others for at least three weeks after the first appearance of the rash, and only then if properly convalescent. Before the child is allowed to leave the sick-room he or she whould have a complete bath and should put on fresh clothing. The discarded clothing, the bedclothes and the room should be appropriately disinfected.
Children who have been in contact with a case of measles should not go back to school until 16 days have elapsed since the last exposure.
The fact of already having had the disease does not preclude the possibility of another attack, as some people have suffered from measles three or four times. In view of the great danger from measles when it occurs in very young children, every effort should be made to postpone the contraction of the disease until after the fifth year of age. Proper medical and nursing care will often serve to prevent complications, and a fatal outcome. Weakly and badly nourished children are the most likely victims.
The mucous membrane which is more commonly affected with catarrh is that covering the eyeballs and eyelids (the conjunctiva), and that lining the nose, the pharynx, the larynx and the air-tubes; other places may also suffer, however.
From time to time the presence in pork and beef of immature forms of a tapeworm necessitates condemnation of the meat. This condition is known as measles. In the pig the meat, and at times the liver, looks mottled; on close examination small cysts can be seen with the naked eye. These vary in size from one-twentieth of an inch to as much as half an inch long. Each of the cysts contains the larval form of a tapeworm. These cysts can also form in man if the eggs of the tapeworm are consumed with or without food, and if they develop in the eye or brain serious results may follow from the increased pressure set up. The appearance of beef measles is very much the same.
If measly meat containing cysts with live contents is eaten raw or insufficiently cooked, the tapeworm will develop in the intestinal canal and may cause anaemia and other symptoms. Thorough cooking of pork and beef kills the larvae in these cysts in beef kept in cold storage or brine for three weeks the larvae are also killed.