MEASLES (Morbilli, Rubeola; German, Maseru; French Rougeoie), an acute infectious disease occurring mostly in children. It appears to have been known from an early period in the history of medicine, mention being made of it in the writings of Rhazes and others of the Arabian physicians in the 10th century. For long, how-ever, its specific nature was not recognized, and 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 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 Ingrassias, a physician of Palermo. It is only within a comparatively recent period that measles has come to be universally regarded as a distinct and independent malady.

Like the other eruptive fevers (exanthemata), to which class of diseases measles belongs, its progress is marked by several stages more or less sharply denned.

After the reception of the contagion into the system a period of incubation or latency precedes the development of the disease, during which scarcely any disturbance of the health is perceptible. This period appears to vary in duration, but it may be stated as generally lasting 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. 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 expectora-tion, hoarseness of the voice, and occasionally sickness and J diarrhoea, are the chief local phenomena of this stage. But along with these there is well-marked febrile disturb-ance, the temperature being elevated (102°-104° F.), and the pulse rapid, while headache, thirst, and restlessness are usually present to a greater or less degree. In some instances, however, these initial symptoms are so slight that they almost escape notice, 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, slightly elevated above the surface, at first isolated, but tending to become grouped together 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 along 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, giving rise to a larger area of uniform redness. 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. Occasionally during convalescence slight peeling of the epidermis takes place, but much less frequently and distinctly than is the case in scarlet fever. At the com-mencement 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 per-fectly well even before the rash has faded from the skin.





Measles may, however, occur in a very severe or 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 of strength, accompanied with intense catarrh of the respiratory or gastro-intestinal mucous membrane. Such cases, always of serious import, are happily 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 met with 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 in the view of medical men 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 unfrequontly, 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), impart a gravity to the case which it did not originally possess. 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 inflam-matory affections of the larynx, with attacks resem-bling croup, and also diarrhoea assuming a dysenteric character. Or there majr 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 even endangering life.

Apart, however, from those immediate risks, it deserves to be borne in mind that in measles there appears to be a tendency in many cases for the disease to leave behind a weakened and vulnerable condition of the general health, wdiich 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 sequeke of measles plainly indicate that although in itself a comparatively mild ailment, it cannot safely 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 now alluded to 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 simply due to the fact that most persons have undergone an attack in early life, since, 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 con-stitutes 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 in two well-known in-stances in recent times,—namely, the epidemic in the Faroe Islands in 1816, 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 were cut off by the disease within a period of about three mouths (see FIJI). In both these cases the great mortality has been ascribed to the complications of the malady, specially induced by over-crowding, by insanitary surroundings, the absence of proper nourishment and nursing for the sick, and the utter prostration and terror of the people, rather than to any marked malignancy in the type of the disease.1 Not a few authorities, however, while fully recognizing the baneful effect of these unfavourable conditions, are yet dis-posed to hold that epidemics of this kind, when occurring in what might be termed a virgin soil, are apt to possess an innate severity. In many lands, such as the United King-dom, measles is rarely absent, especially from large centres of population, where sporadic cases are found in greater or less number 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. There is little doubt too that the contagion may be carried from one place to another by persons themselves unaffected, as well as by clothing, &c, although its tenacity and activity in this respect is apparently much less marked than that of small-pox or scarlet fever. Of the nature of the infecting agent nothing certain is known. Eecent investigations into the mode of origin of others of the acute infectious diseases, and the discovery in the blood and tissues in the case of some of them of lower forms of organic life (bacilli), which can be isolated and can by inoculation be made to communicate the particular malady to which they are related, give countenance to the opinion, now widely entertained, that the infecting principle of the exanthemata is of this nature. The subject, however, is still under investigation, and more information is wanting before definite statements can be made. Second attacks of measles are occasionally observed, but they are rare.





Treatment.-—The treatment of measles "embraces the preventive measures to be adopted in the case of an outbreak 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 already referred to regarding the communic-able period of the disease, ineffectual; nevertheless where practicable it ought to be tried, for it is a grave error needlessly to expose the healthy children in a family to the risk of infection under the idea that they must necessarily take the disease at some time or other. The unaffected children should likewise 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 should be subjected to disinfection or thorough washing. In extensive epidemics it is often desirable to close the schools of a locality for a time. As regards special treat-ment, 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 in such a manner as to avoid the risk of draughts, light nourishing liquid diet (soups, milk, <fcc), and mild diaphoretic remedies such as the acetate of ammonia or ipecacuanha, are all that is necessary in the febrile stage. When the catarrhal symptoms are very severe, the hot bath or warm packing to the body generally or to the chest and throat afford relief, and the same measures may with advantage be adopted should the eruption be but feebly developed or tend to recede, and especially should convulsions set in. 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 inhalation of vapour and the use of the preparations of ammonia are of special efficacy. Diarrhoea is treated by the usual remedies, including carefully administered doses of Dover's powder, chalk, etc. 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 the view of averting the evils, both local and constitutional, which but too often follow this disease.

German Measles (Rotheln, or Epidemic Roseola) is a term applied to a contagious eruptive disorder having certain points of resemblance to measles, and, according to some observers, 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, and is occasionally seen in extensive epidemics. Beyond con-finement 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 rotheln. 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 rotheln either wholly absent or exceedingly slight, enduring only for one day.

2. The eruption of rotheln, 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 no accompanying increase of temperature in this stage as in measles.

3. The milder character of the symptoms of rotheln 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. (J. O. A.)


Footnote

Transactions of the Epidemiological Society. London, 1877.


The above article was written by: J. O. Affleck, M.D.