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Measles and German Measles

fever, rash, skin, period, person and days

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(Plate XXVIII.) Measles (Norbil Itabeola). —This is an infectious disease occurring most commonly among children, not because grown-up people are less liable to be attacked, but because most people have it in childhood, and one attack protects against another. This is not a rule, however, that has no exceptions.

The cause of the disease is, without excep tion, contagion ; that is to say, a special kind of poisonous material is thrown off from the body of a person suffering from measles, which, gaining entrance to the body of a healthy per son, gives rise to a new case of the disease. Measles thus spreads, like scarlet fever, from person to person, one case being capable of infecting any number of others. It clings to clothing and to other surfaces. Many people forget this. Parents too often forget it when they send their children out to play, or back to school, a sufficient time after their recovery, but without previously disinfecting their cloth ing. It is for such reasons that, when one of a family is sick of measles, the others, if they are living in the same house, should be kept at home, not only from school but from playing with neighbours' children, lest they spread the fever. Measles is infectious even before the rash has appeared, and therefore even before the real nature of the affection is quite certain. A patient may, thus, have already imparted the disease to others before it could be known that he was suffering from it. This is different from scarlet fever, in which the chief period of infection is while the scarf-skin is separating— the period of desquamatiou as it is called.

A measles-infected person may infect others during the incubation period, as well as during the period of illness, and for 14 days after the appearance of the rash, that is, during a total period of 4 weeks. Of course the infection may cling to rooms and clothing, that have not been disinfected, for a much longer time.

Symptoms do not show themselves till from twelve to fourteen days after infection. The

attack begins with signs resembling those of cold-in-the-head (catarrh, p. 214). There are chills or shivering fits, in children sometimes convulsions, followed by evident fever. The ' appetite is lost, the tongue white, and there may be vomiting. Cough is present, generally I of a harsh barking character. There is sneezing, the eyes are red and watery and sensitive to light, and the head aches. These symptoms increase up to the fourth day, when the rash begins to appear, at first on the forehead and temples, at the edge of the hair, and then on the cheeks, chin, and neck. It then extends downwards over chest, arms, belly, and legs. On the fourth day the fever seems to be at its height. It may reach 104° Fahrenheit (see p. 38), accompanied by rapid pulse and sometimes de lirium. The rash consists of well-marked, red, roundlet' spots, raised above the skin. Appear ing first here and there, they quickly form groups, which run together into irregular patches. When they are numerous the skin is swollen. The face is thus very red, and irregu larly swollen and rough, when the rash is well out. The spots being raised above the surface, the skin feels very rough, and so measles is easily distinguished front scarlet fever, in which there are uo raised spots but only a general redness. If the rash is well "out" by the fourth day, then on the fifth the fever usually is much diminished, the cough is softer, and the pulse less rapid. Within two days of its appearance the rash begins to fade, disappearing front the different parts in the order in which it came, but leaving a mottling of the skin, of a dusky colour, which does not completely fade for ten days or longer. Very fine scales separate from the skin, of the face and neck in particular, on the disappearance of the rash. In ordinary cases the fever has almost passed away by the seventh day, leaving the patient weak.

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