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C. Rucker</p></div><div class="tei tei-div" style="margin-bottom: 3.00em; margin-top: 3.00em"><p class="tei tei-p" style="margin-bottom: 1.00em">This eBook is for the use of anyone anywhere at no cost + and with almost no restrictions whatsoever. You may copy it, + give it away or re-use it under the terms of the Project + Gutenberg License <a href="#pglicense" class="tei tei-ref">included with this + eBook</a> or online at <a href="http://www.gutenberg.org/license" class="tei tei-xref">http://www.gutenberg.org/license</a></p></div><pre class="pre tei tei-div" style="margin-bottom: 3.00em; margin-top: 3.00em">Title: Measles + +Author: W. C. Rucker + +Release Date: November 29, 2006 [Ebook #19965] + +Language: English + +Character set encoding: UTF-8 + + +***START OF THE PROJECT GUTENBERG EBOOK MEASLES*** +</pre></div> +</div> + +<hr class="doublepage" /><div class="tei tei-div" style="margin-bottom: 5.00em; margin-top: 5.00em"> +<span class="tei tei-pb" id="page001">[pg 001]</span><a name="Pg001" id="Pg001" class="tei tei-anchor"></a> +<p class="tei tei-p" style="margin-bottom: 1.00em">UNITED STATES PUBLIC HEALTH SERVICE</p> +</div> + +<div class="tei tei-div" style="text-align: center; margin-bottom: 5.00em; margin-top: 5.00em"> +<h1 class="tei tei-head" style="text-align: left; margin-bottom: 3.46em; margin-top: 3.46em"><span style="font-size: 173%">MEASLES</span></h1> + +<p class="tei tei-p" style="text-align: center; margin-bottom: 1.00em">By</p> + +<p class="tei tei-p" style="text-align: center; margin-bottom: 1.00em">W. C. RUCKER</p> + +<p class="tei tei-p" style="text-align: center; margin-bottom: 1.00em"><span class="tei tei-hi" style="text-align: center"><span style="font-style: italic">Assistant Surgeon General, United States Public Health Service</span></span></p> + +<div class="tei tei-tb"><hr style="width: 25%" /></div> + +<p class="tei tei-p" style="text-align: center; margin-bottom: 1.00em">SUPPLEMENT NO. 1<br /> +TO THE<br /> +PUBLIC HEALTH REPORTS<br /> +JANUARY 24, 1913</p> + +<p class="tei tei-p" style="text-align: center; margin-bottom: 1.00em">[EDITION OF JUNE, 1916]</p> + +<p class="tei tei-p" style="text-align: center; margin-bottom: 1.00em">WASHINGTON<br /> +GOVERNMENT PRINTING OFFICE<br /> +1916</p> +</div> +</div> + +<div class="tei tei-body" style="margin-bottom: 6.00em; margin-top: 6.00em"> +<hr class="doublepage" /><div class="tei tei-div" style="margin-bottom: 5.00em; margin-top: 5.00em"> +<span class="tei tei-pb" id="page003">[pg 003]</span><a name="Pg003" id="Pg003" class="tei tei-anchor"></a> +<h1 class="tei tei-head" style="text-align: left; margin-bottom: 3.46em; margin-top: 3.46em"><span style="font-size: 173%">MEASLES.</span></h1> + +<p class="tei tei-p" style="margin-bottom: 1.00em">By <span class="tei tei-hi"><span style="font-variant: small-caps">W. C. Rucker</span></span>, Assistant Surgeon General, United States Public Health Service.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Over 11,000 American children died of measles in the year 1910. +This did not include a large number who died of broncho-pneumonia, +a great number of cases of which, in children, are caused by measles. +Sixty-eight and two-tenths per cent of all deaths from broncho-pneumonia +occur in children under 5 years of age, a time of life when +measles is most apt to occur. But the story of the ravages of this +disease is not complete without the mention of the large number of +cases of tuberculosis which follow an attack of it. Less frequently +inflammation of the ear or the eye may be left behind as a mark of a +visitation of this common disease. From a public health standpoint, +then, measles is a disease of prime importance.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Long association with a disease breeds a contempt for it, and +measles, in common with the other diseases of childhood, has come +to be looked upon as an unavoidable accompaniment of youth.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Each autumn when school opens there is an increase in the number +of cases of measles, and as the season progresses they gradually +increase, and winter frequently sees the disease spreading in epidemic +form. Hirsch has collected data of 309 epidemics of measles, and +has classified them according to season; summer had 43, autumn had +76, winter had 96, and spring had 94 epidemics.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Measles is a disease of close association; hence its increase during +the colder months.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Frequently a child will go to a party and engage in innocent games +in which children are brought in close contact with one another. +Perhaps among the guests there is one with reddened, watery, eyes, +which are sensitive to light. The eyelids are perhaps a little puffy, +and the guest has a hard, high-pitched cough. The other children +pay no attention to this, and the games go on uninterruptedly. In +this way a single child in the beginning stages of measles may easily +affect 15 or 20 others. This is frequently the case when kissing games +are played.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">About 10 days later the children who have exposed themselves to +the disease begin to sicken. They, too, have red, watery, sensitive +eyes and puffy eyelids. In fact, in rather severe cases the whole face +has a rather swollen, puffed appearance. The throat feels parched +and a dry, irritating cough increases the discomfort. The child is apt +to come home from school feeling drowsy and irritable, not infrequently +complains of chilly sensations, and may even have a chill.<span class="tei tei-pb" id="page004">[pg 004]</span><a name="Pg004" id="Pg004" class="tei tei-anchor"></a> +At night the irritation increases, the child is feverish, the whites of +the eyeballs show little red lines upon them, and the little sufferer +has the appearance of being just ready to cry.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">If the anxious mother takes the child to the window in the morning, +raises the curtain, and examines the little one's throat she will +see that the hard palate and back of the throat are a dull, angry red. +Perhaps there are a few little red spots on the hard palate, and if +the mother will look closely at the lining membrane of the cheek she +will see some small white-tipped, reddish spots. These are called +"Koplik's" spots, and are one of the signs of measles.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">The child is kept from school that day, and that night his fever is +higher than it was the night before. He rolls and tosses about the +bed and wakes up his mother a good many times to ask for a drink +of water. This sort of thing continues for 3 or 4 days; then, one morning +when the child is having its bath the mother sees some little +dusky red spots along the hair line. They look a good deal like flea +bites. Within 24 hours this rash is spread over the body and the +child looks very much bespeckled and swollen. In from 5 to 7 days +the rash begins to fade, and within 3 or 4 days thereafter is entirely +gone away, leaving behind a faint mottling of the skin. This is followed +by a peeling off of the outer layer of the skin in little bran-like +pieces. This process is called desquamation, and lasts about a week +or 10 days.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">In the meantime the fever has gone away, and as soon as the child +has finished scaling he is permitted to go out and play with the other +children, and before long is back at school. The foregoing is a description +of a mild case.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">If measles assume a malignant type, as it sometimes does among +the nonrobust, it may be ushered in by convulsions, very high fever, +and an excessive development of all the ordinary symptoms, or the +rash when it appears, instead of being a good healthy-looking red, +may be a bluish-black discoloration which looks like a recent bruise. +Broncho-pneumonia, the most common and the most fatal of all the +complications of measles, is very apt to occur. The cough is very +painful, and death quickly relieves the sufferer.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">The two forms of the disease which have just been cited are in no +way exaggerated and unfortunately they are of far too common occurrence. +The first child received the infection directly in the harmless +games at the party by coming in intimate contact with a child who +was just coming down with measles at a time when, according to the +researches of Anderson and Goldberger in the Hygienic Laboratory of +the United States Public Health Service, the infecting virus is most +active. Their work seems to show that the infection does not persist +after the fever has gone away.</p> + +<span class="tei tei-pb" id="page005">[pg 005]</span><a name="Pg005" id="Pg005" class="tei tei-anchor"></a> + +<p class="tei tei-p" style="margin-bottom: 1.00em">While all of the severe cases may not be as grave as the one which +was cited above, it must be admitted, nevertheless, that broncho-pneumonia +is the great menace of measles. Fifty-odd years ago +Gregory wrote "I am sure I speak much within bounds when I say +that nine-tenths of the deaths by measles occur in consequence of +pneumonia." Less frequently there are other complications, and the +eyes, ears, the central nervous system, heart, and the skin may any +one of them suffer. Sometimes there is gangrene at the corners of the +mouth and this may result in death or horrible deformity.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Measles, then, is a serious disease, sparing practically no exposed +person who has not had it. In 1846 it attacked the Faroe Islands, +and the record of that visitation is both remarkable and instructive. +The island had been free from the disease for 65 years, when a Danish +cabinetmaker returned from Copenhagen to Thorshavn with the +disease. He infected two friends, and the epidemic increased by +leaps and bounds, until within a very short time over 6,000 persons +out of a population of 7,782 were attacked. Almost every house on +the island became a hospital, and the only persons who passed through +the visitation unscathed were old inhabitants who had had the +disease as children 65 years before. Not a single old person who was +not protected by a previous attack and who was exposed to the +infection failed to contract the disease.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">This is one of the oldest ailments with which man has been afflicted. +In fact the word "measles" traces its genealogy back through the +German "masern" to the Sanskrit "masura," a word meaning "spots." +The writings of the ancient Arabian physicians are replete with +mention of this disease. The Italians, who evidently regarded it no +more seriously than we do, called it "morbillo," which means "little +sickness."</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Time and again measles has been widely diffused on Asiatic and European +soil, and shortly after the colonization of America it appeared in +our colonies. Many are the quaint records of its visitations, not the +least interesting of which is a letter which appeared in the Boston +Evening Post, November 12, 1739, entitled "A letter about good management +under the distemper of measles at this time spreading in +the country, here published for the benefit of the poor and such as +may want help of able physicians." It is signed "Your hearty friend +and servant," and the authorship is attributed to Cotton Mather. It +is stated that this letter is a reprint of one which Dr. Mather wrote +prior to his death in 1728.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">At present the disease is distributed over the entire habitable globe, +from Iceland on the north to Tierra del Fuego on the south. It occurs +most often and more severely in the colder months, probably because +at such times people are more closely crowded together under more<span class="tei tei-pb" id="page006">[pg 006]</span><a name="Pg006" id="Pg006" class="tei tei-anchor"></a> +insanitary conditions. When introduced among a people who have +never suffered from it before, its ravages are frightful, as in the case +of the inhabitants of certain of the Fiji Islands, who, upon being +exposed to the infection, fell ill and died by thousands, so that it +is estimated that 20,000 deaths occurred in four months. The epidemic +ceased only when almost every person on the island had been +infected.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">During the year 1910 the death rates from this disease in the States +of Rhode Island and North Carolina were 32.6 and 27.1 per 100,000 +inhabitants.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">In the same year the death rate per 100,000 from measles in Pittsburgh, +Pa., was 33.1; Providence, R. I., 31.9; Kansas City, Mo., +28.4; Lowell, Mass., 28.1; Albany, N. Y., 23.9; Columbus, Ohio, +23.6; Buffalo, N. Y., 22.1; and Richmond, Va., 21.1.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">The death rate among those attacked varies from 1/2 to 35 per cent. +If it is estimated that the death rate is 1 per cent, and the number +of deaths from it in the United States during the year 1910 was 11,000, +then it would follow that during that year at least 1,100,000 children +suffered from this disease. When it is considered that perhaps 30 +per cent of these children were of school age, and that the disease +occurs most often during the months of school attendance, then it +will be seen that 330,000 children were kept from school from six +weeks to two months on account of measles. Leaving out of consideration +the death and suffering which was produced in this way, +this is a serious economic loss.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Measles is a frequent accompaniment of war, or any other occasion +which brings large numbers of persons together under unhygienic +conditions. In fact, measles is one of the most formidable of camp +diseases. This fact is well demonstrated by morbidity and mortality +statistics of the Civil War. At that time the mortality rate was very +high in the general field hospital at Chattanooga, being 22.4 per cent, +and in the general field hospital at Nashville it was 19.6 per cent. In +1865 there were 38,000 cases with 1,900 deaths from measles in the +Confederate army. It is reported that during the Brazilio-Paraguayan +War an epidemic of measles swept off nearly a fifth of the +Paraguayan army in three months.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">It is thus seen that measles is many times a very severe disease, +one which can not be dealt with lightly, one to which we should not +expose our children. A child with measles should be put to bed +and kept there as long as it has any fever or cough. The room should +be airy, but it should be darkened, because children with measles are +very sensitive to light. The bedclothes should be light, because the +child is apt to get too warm, kick off the covers, and suffer from the +cold. A chilling in this way may predispose to pneumonia. Food +should be light and should consist chiefly of nutritious broths, pasteurized<span class="tei tei-pb" id="page007">[pg 007]</span><a name="Pg007" id="Pg007" class="tei tei-anchor"></a> +milk, soft-boiled eggs, and the like. Ice lemonade will +bring comfort to the inflamed throat. The child's eyes should be +kept clean, and should the fever get high the comfort of the little +sufferer may be increased by sponging with tepid water and alcohol. +Sometimes it is necessary to put an ice bag to the head, but, if the +child is sick enough to require this, skilled assistance should be +summoned.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">When the fever and cough have gone the child may be allowed +to be up and about the room, but for a time should not indulge +in violent exercise, because there is often some weakening of the +heart muscle by the disease. The aim is to allow the heart muscle +to regain its normal condition before putting too much strain upon +it. The diet should be increased when the fever has gone away, +and should include good, plain, strong foods. If there is a tendency +to regain weight and strength slowly, the child may be given +an increased amount of pasteurized cream or good butter. If the +child prefers cod-liver oil, this may be substituted.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">The important point about the prevention of the disease is the fact +that, judging from the experiments of Anderson and Goldberger +above referred to, measles is rarely transmissible after the fever has +gone down. Experimenting with monkeys, they found that they +were unable to transmit measles from monkey to monkey after the +stage of fever had ceased. It used to be thought that the germs of +measles were in the scales of skin which were shed at the close of the +disease.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">It is thought by some that there may be chronic carriers of measles, +but this is not at all proven. It is also believed that a discharging +ear following measles may be the means of continuing the transmission +of the disease. This is not proven. There are on record a +large number of instances which seem to point to the fact that under +certain conditions a third person may carry the infection from the +sick to the well. Transmission of measles to human beings by the +lower animals is still unproven.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">It is not known what the cause of measles is. A great many +scientists have described germs which they believe to be the causal +agents, but up to date these have not been positively proven as the +cause of measles. We do, however, know that the infection of measles +is found in the secretions from the nose and throat during the first +stages of the disease; therefore persons suffering with measles should +not be allowed to come in contact with well persons until the period +of fever has well passed.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Since the disease is known to be spread by the sputum, the prime +measure in the prevention of this disease is to prevent the sputum +from the sick being taken into the system of well persons. Children +with measles should be provided with a quantity of soft paper napkins,<span class="tei tei-pb" id="page008">[pg 008]</span><a name="Pg008" id="Pg008" class="tei tei-anchor"></a> +and as soon as the napkins become soiled they should be burned. +Children should be taught that they must always hold a handkerchief +in front of the mouth while coughing. This is a measure which tends +to control the spread of a good many diseases besides measles, because +during coughing and sneezing sputum may be thrown several feet. +Everything which has come in contact with measles patients should +be sterilized before it is allowed to come in contact with other people +or other things which may be handled or used by other people. Bedclothes, +napkins, table linen, towels, and the like may be sterilized by +boiling.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">When it is known that measles exists in a community, no child having +a bad cough should be allowed to come in contact with other +children during the first three or four days of the cough.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">It is little less than criminal to permit children known to have +measles to come in contact with well children. In this connection +it may be remarked that while it is generally considered that one +attack of measles confers immunity, there are many cases on record +of second and third attacks. It is true that the second attacks are +usually very mild, but too great reliance should not be placed on this +immunity.</p> + +<p class="tei tei-p" style="margin-bottom: 1.00em">Children should be discouraged as far as possible from playing +games which will permit of an interchange of nasal or mouth secretions. +It is the duty of every parent having measles in the home to +see to it that it is reported to the public-health authorities. It is +equally the duty of parents to see to it that their children do not +come in contact with well children during the time when the infection +may be transmitted. Measles kills more people in the United States +every year than smallpox. You can't kill a child any deader with +smallpox than you can with measles. It is the duty of private citizens +and municipalities to take every known measure for the prevention of +the spread of this disease.</p> +</div> +</div> + +<hr class="doublepage" /><div class="tei tei-back" style="margin-bottom: 2.00em; margin-top: 6.00em"> +<div class="tei tei-div" style="margin-bottom: 5.00em; margin-top: 5.00em"> +<div id="pgfooter" class="tei tei-div" style="margin-bottom: 4.00em; margin-top: 4.00em"><pre class="pre tei tei-div" style="margin-bottom: 3.00em; margin-top: 3.00em">***END OF THE PROJECT GUTENBERG EBOOK MEASLES*** +</pre><hr class="doublepage" /><div class="tei tei-div" style="margin-bottom: 3.00em; margin-top: 3.00em"><a name="rightpageheader1" id="rightpageheader1"></a><a name="pgtoc2" id="pgtoc2"></a><a name="pdf3" id="pdf3"></a><h1 class="tei tei-head" style="text-align: left; margin-bottom: 3.46em; margin-top: 3.46em"><span style="font-size: 173%">Credits</span></h1><table summary="This is a list." class="tei tei-list" style="margin-bottom: 1.00em; margin-top: 1.00em"><tbody><tr><th class="tei tei-label tei-label-gloss">November 29, 2006 </th></tr><tr><td class="tei tei-item"><table summary="This is a list." class="tei tei-list" style="margin-bottom: 1.00em; margin-top: 1.00em"><tbody><tr class="tei tei-labelitem"><th class="tei tei-label"></th><td class="tei tei-item">Project Gutenberg Edition</td></tr><tr class="tei tei-labelitem"><th class="tei tei-label"></th><td class="tei tei-item"><span class="tei tei-respStmt"> + <span class="tei tei-name">Bryan Ness<br /></span> + <span class="tei tei-name">Joshua Hutchinson<br /></span> + <span class="tei tei-name">Online Distributed Proofreading Team</span> + </span></td></tr></tbody></table></td></tr></tbody></table></div><hr class="doublepage" /><div class="tei tei-div" style="margin-bottom: 3.00em; margin-top: 3.00em"><a name="rightpageheader4" id="rightpageheader4"></a><a name="pgtoc5" id="pgtoc5"></a><a name="pdf6" id="pdf6"></a><h1 class="tei tei-head" style="text-align: left; margin-bottom: 3.46em; margin-top: 3.46em"><span style="font-size: 173%">A Word from Project Gutenberg</span></h1><p class="tei tei-p" style="margin-bottom: 1.00em">This file should be named + 19965-h.html or + 19965-h.zip.</p><p class="tei tei-p" style="margin-bottom: 1.00em">This and all associated files of various formats will be found + in: + + <a href="http://www.gutenberg.org/dirs/1/9/9/6/19965/" class="block tei tei-xref" style="margin-bottom: 1.80em; margin-left: 3.60em; margin-top: 1.80em; margin-right: 3.60em"><span style="font-size: 90%">http://www.gutenberg.org</span><span style="font-size: 90%">/dirs/1/9/9/6/19965/</span></a></p><p class="tei tei-p" style="margin-bottom: 1.00em">Updated editions will replace the previous one — the old + editions will be renamed.</p><p class="tei tei-p" style="margin-bottom: 1.00em">Creating the works from public domain print editions means that + no one owns a United States copyright in these works, so the + Foundation (and you!) can copy and distribute it in the United + States without permission and without paying copyright royalties. + Special rules, set forth in the General Terms of Use part of this + license, apply to copying and distributing Project Gutenberg™ electronic works + to protect the Project Gutenberg™ concept and trademark. 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