It is very common for the cough to be the first thing to attract attention. A child, who has been restless during the day, rouses its parents in the night by a hoarse barking cough, which immediately suggests croup to their minds. It has not the metallic, brassy ring of croup, however, for which it may be mistaken till, in one or two days, the measles rash ap pears.
Measles is not the very simple disease that many people seem to imagine. Bronchitis is a very common complication, maintaining the high fever beyond the sixth or seventh day, delaying recovery, or causing death. In young children the attack of the disease with the ac companying affection of the chest may be so severe as to cause death before the rash has time to appear. In hot weather an attack of diarrhoea is serious, and in hot climates dysen tery is not an infrequent bad attendant of the attack. In delicate children, measles is apt to leave very weakened conditions of general health. Inflammation of the eyes, discharges from the ears, and swellings of glands often follow an attack of measles in unhealthy chil dren, and are very difficult of cure.
Persons may suffer front measles and mumps or whooping-cough at the same time.
Treatment.—From the very beginning the patient should be separated from others, and steps should be taken for disinfection, as de scribed on p. 517. The person must be kept quiet in bed in a room kept at a regular degree of warmth, but yet with plenty of pure air. Draughts should be carefully avoided. Sunlight should be freely admitted to the room, but the bed shaded from it. The bed clothing should be light. Milk should be the only diet for a week or ten days, given, a cupful at a time, every two hours or so during the day. If the fever is high and the patient restless, the warm Lysol bath is of great service (see p. 508). The child should get such a full bath for eight minutes morning and evening at a temperature of 98°. The cough may be relieved by gar gling the throat with warm milk or sucking a small piece of ice. To aid the action of the skin and kidneys the mixtures noted on p. 511 may be used as required.
If convulsions occur, a warm bath or pack should be employed (p. 508).
After ten days the food should gradually return to the full ordinary diet. A dose of mild opening medicine is occasionally necessary, but it is to be carefully given, from the risk of looseness of the bowels.
A ffections of the ears and eyes are to be treated as recommended in Section XXIII.
German Measles (False Measles, Rotheln, Rubella, Epidemic Roseola) is apt to be mis taken for measles and scarlet fever. It differs from measles in there being little sneezing, little cough, and nothing of the red watery eyes, all of which are characteristic signs of measles. It is a different disease from measles, for, while one attack of measles protects, as a rule, from a second, an attack of false measles gives no protection from true measles. It never develops into true measles, though a child may have a real attack of measles shortly after an attack of German measles. It is not so contagious as true measles. The affection does not show itself till from one to two weeks after infection.
Symptoms.—The disease is marked by an eruption, appearing first on the face and quickly spreading over forearm and hands, legs and feet, and rapidly covering the whole body. The spots are raised above the skin, of a dusky red, irregular in shape, and they soon run to gether. This eruption is accompanied by little fever. The patient may complain of a feeling of fulness of the head, of giddiness, and perhaps of some headache, in short of being a little "out of sorts," and frequently does not com plain at all. In true measles, as noted on p. 521, there is considerable feVer, with severe cough, sneezing, and other signs of cold-in-the head, and the fever usually reaches its height when the rash appears on the fourth day. Now, in false measles, if there is any disturbance before the fever it is slight, and usually the rash appears within one day, or at the most two days, of the person feeling unwell. It does, however, sometimes happen that there is con siderable fever, loss of appetite, &c., before and during the rash, and in young children the disease occasionally sets in with vomiting, diarrhcea, and convulsions. On the second day the rash is fully out, and immediately begins to disappear, fading by the third or fourth day. A symptom more distinctive than the rash is the presence of enlarged and tender glands down the sides of the neck, at the back of the neck, and sometimes in the armpits and groins.
Treatment.—Rest in bed for three or four days, and such mild diet as recommended for measles are sufficient treatment. The infectious character of the disease must not be forgotten, and, as the infection probably lasts for some weeks, care should be taken that the disease is not spread. The warm Lysol bath should be daily used as recommended on p. 508.