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diff --git a/19965.txt b/19965.txt new file mode 100644 index 0000000..816d9c7 --- /dev/null +++ b/19965.txt @@ -0,0 +1,814 @@ +The Project Gutenberg EBook of Measles by W. C. Rucker + + + +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 included with this eBook or +online at http://www.gutenberg.org/license + + + +Title: Measles + +Author: W. C. Rucker + +Release Date: November 29, 2006 [Ebook #19965] + +Language: English + +Character set encoding: US-ASCII + + +***START OF THE PROJECT GUTENBERG EBOOK MEASLES*** + + + + + +UNITED STATES PUBLIC HEALTH SERVICE + + + + + +MEASLES + + + By + + W. C. RUCKER + + _Assistant Surgeon General, United States Public Health Service_ + + ------------------ + + SUPPLEMENT NO. 1 + TO THE + PUBLIC HEALTH REPORTS + JANUARY 24, 1913 + + [EDITION OF JUNE, 1916] + + WASHINGTON + GOVERNMENT PRINTING OFFICE + 1916 + + + + + + +MEASLES. + + +By W. C. RUCKER, Assistant Surgeon General, United States Public Health +Service. + +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. + +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. + +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. + +Measles is a disease of close association; hence its increase during the +colder months. + +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. + +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. 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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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." + +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. + +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 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. + +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. + +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. + +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. + +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. + +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 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. + +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. + +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. + +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. + +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. + +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, 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. + +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. + +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. + +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. + + + + + + +***END OF THE PROJECT GUTENBERG EBOOK MEASLES*** + + + +CREDITS + + +November 29, 2006 + + Project Gutenberg Edition + Bryan Ness + Joshua Hutchinson + Online Distributed Proofreading Team + + + +A WORD FROM PROJECT GUTENBERG + + +This file should be named 19965.txt or 19965.zip. + +This and all associated files of various formats will be found in: + + + http://www.gutenberg.org/dirs/1/9/9/6/19965/ + + +Updated editions will replace the previous one -- the old editions will be +renamed. + +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. 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