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Measles

disease, infected, persons, virus, transmission, particularly and time

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MEASLES is one of the commonest infectious diseases of childhood. Jurgenson gives the eighteenth century as the date of its definite recog nition as an epidemic disease. The first important clinical and epi demiological article, dealing particularly with the incubation stage, was by Panum in 1546 giving his observations during an outbreak of measles in the Faroe Islands. Since that time much has been done and published from many sources confirming Panum's observations. In the year 1575 the interesting opportunity again occurred to observe the development and spread of this infectious disease, in an outbreak so severe that the inhabitants were cut off from communication with the outside world.

Etiology and is produced by an unknown virus which is of a relatively evanescent nature. It is not possible to carry the disease any great distance by a third person or by means of living objects. The virus is short-lived outside the human body and presumably can propagate only within the human body. Whether or not the virus of measles can remain latent in one who has had the disease is still a question.

Time and Mode of transmission of the dis ease from infected persons occurs most easily during the so-called initial or prodromal stage, and at the time of the rash. In the last or stage of convalescence the danger of transmission is not so great. These two first mentioned periods of measles are particularly well adapted to the dissemination of the disease in that during the catarrhal involvement, which predominates and in the course of the sneezing, snuffling, hawk ing, and coughing, the infecting organisms multiply in a most energetic manner, and a still more infective virus is produced. The greatly increased secretion assists in transmission. I recall a case, however, admitted to the Hospital for a subsequent diphtheria, on the fourteenth day after the appearance of the rash, which infected children in the same ward. On the fourteenth day after the admission of this child to the hospital the eruption of measles appeared simultaneously in many of the patients. This ease demonstrates perhaps, the oft-times strik ing stability of the virus of measles in persons recently infected. Measles very readily attacks those who have not previously had the disease. In consequence it always occurs in great epidemics in thickly

peopled areas, returning year after year, particularly in those seasons in which catarrhal conditions are most apt to occur. Conditions which bring together a great number of young persons are favorable to the spread of measles, as for example the schools, playgrounds, children's entertainments, etc. The transmission of measles can result, (1) through direct contact with an infected individual; (2) still much more often the conveying medium is air infected with the poison, and (3) the possibility of infection through the secretions of the mouth, the nose and the respiratory tract, also the blood, lymph, and tears, conveyed by persons, animals, or infected objects.

Indirectly the desquamation from the skin may by reason of its infective nature contribute in the transmission of the disease.

The most important carrier of infection in an indirect way is infected air which, with the help of particles of dust or water drops, serves as a means for spreading the infection, although only for a short distance, as the virus is short-lived in the air. As a result it happens that epidemics of measles occur in the larger cities and more thickly populated districts to a greater extent than in the more sparsely popu lated parts.

There are, it is said, few persons who are immune to measles, for the predisposition of man to the disease is particularly great. Measles is mostly acquired in childhood, the period of life which shows an especially high grade of susceptibility. Adults experience, as in many diseases, more discomfort than younger persons; nevertheless it attacks them much more lightly. The predisposition to the disease in later life is only apparently less, and I have seen a woman sixty-eight years old with measles. The idea that a lesser susceptibility to measles exists in the first six months of life as compared with the later period of child hood, is certainly not correct. Children under six months of age show a diminished intensity of the symptoms, sometimes they are only of a rudimentary character, so that the disease may be overlooked, or a mistake in diagnosis be made. They contract the disease on exposure just as readily as other children.

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