In many lands, such as the United Kingdom, measles is rarely absent from large centres of population, and from time to time epidemics arise among those who have not been protected by a previous attack. The risk of conveying infection is greatest dur ing the catarrhal stage before the rash appears. Hence the diffi culty of timely isolation, and the readiness with which the disease is spread in schools and families. While contagion is generally direct, it can also be conveyed by particles from the nose and mouth which, after being expelled by coughing or sneezing are deposited on clothes, toys, etc.
Treatment.—The treatment embraces isolation of the sick to the fullest possible extent and at as early a period as possible. Epidemics have often been curtailed by such a precaution. The unaffected children in a family should be kept from school for three weeks from the latest possible date of infection, and all clothing in contact with the patient or nurses should be disinfected. In extensive epidemics it is often necessary to close the schools for a time. As regards medical treatment, in an ordinary case of measles little is required beyond what is necessary in febrile con ditions generally. The serious complications call for special meas ures (see BRONCHITIS; PNEUMONIA; etc.). During convalescence the patient must be guarded from exposure to cold. Serum from a convalescent case of measles contains sufficient anti-body to be used as a preventive 5 to Io cc. when injected subcutaneously into an infant when the exposure has not lasted for more than six days will either prevent the disease or greatly lessen its severity. Thirty cc. of blood from a person who has had measles
in childhood equals 5 cc. of convalescent serum.
"German measles" (Rfitheln, or Epidemic Roseola) is a con tagious eruptive disorder resembling both measles and scarlet fever, but exhibiting its distinct individuality in protecting from neither. It occurs most commonly in children, and is occasionally seen in extensive epidemics. Beyond isolation, no special treat ment is called for. 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 : (I) the stage of invasion, which in measles lasts four days and is accompanied by fever and catarrh, in rotheln is either absent or slight, and lasts only for one day. (2) The erup tion of rotheln, although as regards its locality and manner of progress similar to measles, differs in appearance, the spots being smaller, paler 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) White spots on the buccal mucous membrane, found in measles, do not occur in rotheln. (4) The milder character of rotheln throughout its whole course, and the absence of complications.