MEASLES.

By W. C. Rucker, Assistant Surgeon General, United States Public Health Service.

Over 11,000 American children died of measles in the year 1910. This did not include a large number who died of broncho-pneumonia, a great number of cases of which, in children, are caused by measles. Sixty-eight and two-tenths per cent of all deaths from broncho-pneumonia occur in children under 5 years of age, a time of life when measles is most apt to occur. But the story of the ravages of this disease is not complete without the mention of the large number of cases of tuberculosis which follow an attack of it. Less frequently inflammation of the ear or the eye may be left behind as a mark of a visitation of this common disease. From a public health standpoint, then, measles is a disease of prime importance.

Long association with a disease breeds a contempt for it, and measles, in common with the other diseases of childhood, has come to be looked upon as an unavoidable accompaniment of youth.

Each autumn when school opens there is an increase in the number of cases of measles, and as the season progresses they gradually increase, and winter frequently sees the disease spreading in epidemic form. Hirsch has collected data of 309 epidemics of measles, and has classified them according to season; summer had 43, autumn had 76, winter had 96, and spring had 94 epidemics.

Measles is a disease of close association; hence its increase during the colder months.

Frequently a child will go to a party and engage in innocent games in which children are brought in close contact with one another. Perhaps among the guests there is one with reddened, watery, eyes, which are sensitive to light. The eyelids are perhaps a little puffy, and the guest has a hard, high-pitched cough. The other children pay no attention to this, and the games go on uninterruptedly. In this way a single child in the beginning stages of measles may easily affect 15 or 20 others. This is frequently the case when kissing games are played.

About 10 days later the children who have exposed themselves to the disease begin to sicken. They, too, have red, watery, sensitive eyes and puffy eyelids. In fact, in rather severe cases the whole face has a rather swollen, puffed appearance. The throat feels parched and a dry, irritating cough increases the discomfort. The child is apt to come home from school feeling drowsy and irritable, not infrequently complains of chilly sensations, and may even have a chill.[pg 004] At night the irritation increases, the child is feverish, the whites of the eyeballs show little red lines upon them, and the little sufferer has the appearance of being just ready to cry.

If the anxious mother takes the child to the window in the morning, raises the curtain, and examines the little one's throat she will see that the hard palate and back of the throat are a dull, angry red. Perhaps there are a few little red spots on the hard palate, and if the mother will look closely at the lining membrane of the cheek she will see some small white-tipped, reddish spots. These are called "Koplik's" spots, and are one of the signs of measles.

The child is kept from school that day, and that night his fever is higher than it was the night before. He rolls and tosses about the bed and wakes up his mother a good many times to ask for a drink of water. This sort of thing continues for 3 or 4 days; then, one morning when the child is having its bath the mother sees some little dusky red spots along the hair line. They look a good deal like flea bites. Within 24 hours this rash is spread over the body and the child looks very much bespeckled and swollen. In from 5 to 7 days the rash begins to fade, and within 3 or 4 days thereafter is entirely gone away, leaving behind a faint mottling of the skin. This is followed by a peeling off of the outer layer of the skin in little bran-like pieces. This process is called desquamation, and lasts about a week or 10 days.

In the meantime the fever has gone away, and as soon as the child has finished scaling he is permitted to go out and play with the other children, and before long is back at school. The foregoing is a description of a mild case.

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,