Measles

Measles, (Morbilli, Rubeola; the M. E. word is maseles, properly a diminutive of a word meaning “spot,” O.H.G. māsa, cf. “mazer”; the equivalent is Ger. Masern; Fr. Rougeole), an acute infectious disease occurring mostly in children. It is mentioned in the writings of Rhazes and others of the Arabian physicians in the 10th century. For long, however, it was held to be a variety of small-pox. After the non-identity of these two diseases had been established, measles and scarlet-fever continued to be confounded with each other; and in the account given by Thomas Sydenham of epidemics of measles in London in 1670 and 1674 it is evident that even that accurate observer had not as yet clearly perceived their pathological distinction, although it would seem to have been made a century earlier by Giovanni Filippo Ingrassias (1510-1580), a physician of Palermo. The specific micro-organism responsible for measles has not been definitely isolated.

Its progress is marked by several stages more or less sharply defined. After the reception of the contagion into the system, there follows a period of incubation or latency during which scarcely any disturbance of the health is perceptible. This period generally lasts for from ten to fourteen days, when it is followed by the invasion of the symptoms specially characteristic of measles. These consist in the somewhat sudden onset of acute catarrh of the mucous membranes. At this stage minute white spots in the buccal mucous membrane frequently occur; when they do, they are diagnostic of the disease. Sneezing, accompanied with a watery discharge, sometimes bleeding, from the nose, redness and watering of the eyes, cough of a short, frequent, and noisy character, with little or no expectoration, hoarseness of the voice, and occasionally sickness and diarrhoea, are the chief local phenomena of this stage. With these there is well-marked febrile disturbance, the temperature being elevated (102°-104° F.), and the pulse rapid, while headache, thirst, and restlessness are usually present. In some instances, these initial symptoms are slight, and the child is allowed to associate with others at a time when, as will be afterwards seen, the contagion of the disease is most active. In rare cases, especially in young children, convulsions usher in, or occur in the course of, this stage of invasion, which lasts as a rule for four or five days, the febrile symptoms, however, showing some tendency to undergo abatement after the second day. On the fourth or fifth day after the invasion, sometimes later, rarely earlier, the characteristic eruption appears on the skin, being first noticed on the brow, cheeks, chin, also behind the ears, and on the neck. It consists of small spots of a dusky red or crimson colour, just like flea-bites, slightly elevated above the surface, at first isolated, but tending to become grouped into patches of irregular, occasionally crescentic, outline, with portions of skin free from the eruption intervening. The face acquires a swollen and bloated appearance, which, taken with the catarrh of the nostrils and eyes, is almost characteristic, and renders the diagnosis at this stage a matter of no difficulty. The eruption spreads downwards over the body and limbs, which are soon thickly studded with the red spots or patches. Sometimes these become confluent over a considerable surface. The rash continues to come out for two or three days, and then begins to fade in the order in which it first showed itself, namely from above downwards. By the end of about a week after its first appearance scarcely any trace of the eruption remains beyond a faint staining of the skin. Usually during convalescence slight peeling of the epidermis takes place, but much less distinctly than is the case in scarlet fever. At the commencement of the eruptive stage the fever, catarrh, and other constitutional disturbance, which were present from the beginning, become aggravated, the temperature often rising to 105° or more, and there is headache, thirst, furred tongue, and soreness of the throat, upon which red patches similar to those on the surface of the body may be observed. These symptoms usually decline as soon as the rash has attained its maximum, and often there occurs a sudden and extensive fall of temperature, indicating that the crisis of the disease has been reached. In favourable cases convalescence proceeds rapidly, the patient feeling perfectly well even before the rash has faded from the skin.

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.

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. Not unfrequently, however, these symptoms, instead of abating, become aggravated, and bronchitis of the capillary form (see Bronchitis), or pneumonia, generally of the diffuse or lobular variety (see Pneumonia), supervene. By far the greater proportion of the mortality in measles is due to its complications, of which those just mentioned are the most common, but which also include inflammatory affections of the larynx, with attacks resembling croup, and also diarrhoea assuming a dysenteric character. Or there may remain as direct results of the disease chronic ophthalmia, or discharge from the ears with deafness, and occasionally a form of gangrene affecting the tissues of the mouth or cheeks and other parts of the body, leading to disfigurement and gravely endangering life.

Apart from those immediate risks there appears to be a tendency in many cases for the disease to leave behind a weakened and vulnerable condition of the general health, which may render children, previously robust, delicate and liable to chest complaints, and is in not a few instances the precursor of some of those tubercular affections to which the period of childhood and youth is liable. These various effects or sequelae of measles indicate that although in itself a comparatively mild ailment, it should not be regarded with indifference. Indeed it is doubtful whether any other disease of early life demands more careful watching as to its influence on the health. Happily many of those attending evils may by proper management be averted.

Measles is a disease of the earlier years of childhood. Like other infectious maladies, it is admittedly rare, though not unknown, in nurslings or infants under six months old. It is comparatively seldom met with in adults, but this is due to the fact that most persons have undergone an attack in early life. Where this has not been the case, the old suffer equally with the young. All races of men appear liable to this disease, provided that which constitutes the essential factor in its origin and spread exists, namely, contagion. Some countries enjoy long immunity from outbreaks of measles, but it has frequently been found in such cases that when the contagion has once been introduced the disease extends with great rapidity and virulence. This was shown by the epidemic in the Faroe Islands in 1846, where, within six months after the arrival of a single case of measles, more than three-fourths of the entire population were attacked and many perished; and the similarly produced and still more destructive outbreak in Fiji in 1875, in which it was estimated that about one-fourth of the inhabitants died from the disease in about three months. In both these cases the great mortality was due to the complications of the malady, specially induced by overcrowding, insanitary surroundings, the absence of proper nourishment and nursing for the sick, and the utter prostration and terror of the people, and to the disease being specially malignant, occurring on what might be termed virgin soil.1 It may be regarded as an invariable rule that the first epidemic of any disease in a community is specially virulent, each successive attack conferring a certain immunity.

In many lands, such as the United Kingdom, measles is rarely absent, especially from large centres of population, where sporadic cases are found at all seasons. 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. Hence the difficulty of timely isolation, and the readiness with which the disease is spread in schools and families. The contagion is present in the skin and the various secretions. While the contagion is generally direct, it can also be conveyed by the particles from the nose and mouth which, after being expelled, become dry and are conveyed as dust on clothes, toys, &c. Fortunately the germs of measles do not retain their virulence long under such conditions, comparing favourably with those of some other diseases.

Treatment.—The treatment embraces the preventive measures to be adopted by the isolation of the sick at as early a period as possible. Epidemics have often, especially in limited localities, been curtailed by such a precaution. In families with little house accommodation this measure is frequently, for the reason given regarding the communicable period of the disease, ineffectual; nevertheless where practicable it ought to be tried. The unaffected children should be kept from school for a time (probably about three weeks from the outbreak in the family would suffice if no other case occur in the interval), and all clothing in contact with the patient or nurses should be disinfected. In extensive epidemics it is often desirable to close the schools for a time. As regards special treatment, in an ordinary case of measles little is required beyond what is necessary in febrile conditions generally. Confinement to bed in a somewhat darkened room, into which, however, air is freely admitted; light, nourishing, liquid diet (soups, milk, &c.), water almost ad lib. to drink, and mild diaphoretic remedies such as the acetate of ammonia or ipecacuanha, are all that is necessary in the febrile stage. When the fever is very severe, sponging the body generally or the chest and arms affords relief. The serious chest complications of measles are to be dealt with by those measures applicable for the relief of the particular symptoms (see Bronchitis; Pneumonia). The preparations of ammonia are of special efficacy. During convalescence the patient must be guarded from exposure to cold, and for a time after recovery the state of the health ought to be watched with a view of averting the evils, both local and constitutional, which too often follow this disease.

“German measles” (Rötheln, or Epidemic Roseola) is a term applied to a contagious eruptive disorder having certain points of resemblance to measles, and also to scarlet fever, but exhibiting its distinct individuality in the fact that it protects from neither of these diseases. It occurs most commonly in children, but frequently in adults also, and is occasionally seen in extensive epidemics. Beyond confinement to the house in the eruptive stage, which, from the slight symptoms experienced, is often difficult of accomplishment, no special treatment is called for. There is little doubt that the disease is often mistaken for true measles, and many of the alleged second attacks of the latter malady are probably cases of rötheln. The chief points of difference are the following: (1) The absence of distinct premonitory symptoms, the stage of invasion, which in measles is usually of four days’ duration, and accompanied with well-marked fever and catarrh, being in rötheln either wholly absent or exceedingly slight, enduring only for one day. (2) The eruption of rötheln, which, although as regards its locality and manner of progress similar to measles, differs somewhat in its appearance, the spots being of smaller size, paler colour, and with less tendency to grouping in crescentic patches. The rash attains its maximum in about one day, and quickly disappears. There is not the same increase of temperature in this stage as in measles. (3) The presence of white spots on the buccal mucous membrane, in the case of measles. (4) The milder character of the symptoms of rötheln throughout its whole course, and the absence of complications and of liability to subsequent impairment of health such as have been seen to appertain to measles.

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1 Transactions of the Epidemiological Society (London, 1877).