Of the intestinal disturbances, only the severe dysenteric lesions are to be feared as dangerous to life. The early intestinal disturbances are mostly slight and of short duration.
Prophylaxis.—By reason of the easy transmission of measles in the early stages, precautionary measures to prevent the infection often come too late, and the children who are thus carefully isolated from the patient, share one after another the lot of their companions, unless they possess a high grade of immunity against measles and that is rare. On this account in many of the villages of Southern Germany the cus tom prevails of intentionally putting the children who have not had the disease into houses where measles exists, so that by close contact they may contract it as soon as possible, since it is regarded as inevita ble and so little to be feared. Separation of the members of the family from those who have measles may be regarded as useless, unless it is done at the very onset of the initial stage (i.e., beginning of Koplik spots) and therefore after a very short exposure. On the other hand it is well to take precautions against the extension of the disease to other communities, as measles is transmitted over great distances with great difficulty, if at all. School physicians together with the teachers, are called upon, especially at the time when respiratory catarrh is prevalent, (considering the predisposition to measles), to take precautionary measures by timely inspection, in the earliest stage of disease, to protect the children who are still unaffected as well as the rest of the community. This is to be accomplished by immediate inspection from house to house, and by the closing of the schools.
The child who has had measles should remain away from school for at least three weeks from the beginning of the illness. This applies also to the children of the family who have been exposed but not iso lated. if these were immediately separated from the patient, and taken to another residence, sixteen days quarantine is sufficient before they return to school. Just as in the case of schools, so may other gatherings of young persons during an epidemic serve as the origin of infection, such as at children's parties, play grounds, games, etc. The anxiety as to a second attack is usually not justifiable when the first attack was surely measles. It can, however, certainly occur, but it is very rare.
It is well to shield from measles, children under theee years of age, those that are weakly, those predisposed to catarrhal affections, those whose brothers and sisters have died from tuberculous meningitis, and those predisposed to tuberculosis, or who have already suffered from it, or from haemorrhages or any other malady. Existing chicken-pox and whooping-cough are said to produce a heightened susceptibility t.o measles though personally I have not as yet observed it.
If the disease is in the incubation or prodromal stage the child is to be protected from taking cold, which will at any rate have a therapeutic effect. In the stage of incubation the child may be carefully taken into the fresh air, but in the prodromal stage, the bed is recommended. Special care for fear of taking cold (pseudocroup, pneumonia), is neces sary when the prodromal period is protracted.
Cleanliness and other hygienic rules are the most important pro phylactic measures during and after the illness. The sick room should accordingly have dry walls, and contain the purest possible air, should be large and bright., not situated on the ground floor, and should have windows opening to the south or west. The temperature should range from 15°-16° C. (57°-60° F.) the moisture of the air must be controlled, for we know that with measles in unhygienic and badly-ventilated rooms with deficient change of air, affections of the respiratory tract much more often develop, and run a relatively more severe course. Frequent change of body and bed linen, previously warmed, is advisable, and the bed clothes should retain the heat well, but should not be too heavy. The daily bathing of the face and hands with lukewarm water is regu larly to be carried out. The care of the mouth several times a day is necessary and proper, for this in itself may obviate the occurrence of the various affections likely to arise during the disease. I mention these hygienic rules, which speak for themselves, because it is found that even in the better and more intelligent classes of the community a real fear exists regarding the washing of the patient and the changing of his garments.