From a report by the U.S. Public Health Service as reported in the February 1940 issue of The Southern Farmer
Perhaps the most contagious, most readily transmitted and positively one of the most dangerous of the communicable diseases of childhood, measles, is a disease which parents are included still to consider too lightly.
While persons of all ages are more or less susceptible, measles occurs most commonly in children, 97 percent of the cases being reported before the age of 15.
It is universally prevalent but not always in epidemic form. Perhaps 90 percent of all people over 20 in the United States have had the disease. Only rarely does one go through life without experiencing an attack.
Measles ordinarily is most prevalent from January through April, and twice as many epidemics occur during the colder months as have been noted during the warmer season of the year.
In a typical case of measles symptoms appear from 10 to 12 days after exposure. Occasionally the incubation period may be shorter or longer.
The disease is ushered in by catarrhal symptoms of the eyes, nose and respiratory tract, and fever. In addition there may be loss of appetite, chilliness, vomiting, diarrhea and nervous irritability. These symptoms are usually proportionate to the height of the fever and the severity of the catarrhal symptoms.
The eyes are characteristically red and swollen and markedly sensitive to light. There may be an irritative discharge from the nose and the patient is further annoyed by frequent attacks of sneezing and a dry, hacking cough.
After a day or so the temperature tends to recede and to remain normal until the rash appears.
About the fourth day, the eruption is seen, first behind the ears and on the neck and forehead. Within 36 hours it may have spread all over the body. The skin itches and burns.
With the appearance of the rash the fever rises again and all other symptoms increase in intensity. When the eruption reaches its height, the fever begins to decline, reaching normal in from 24 to 48 hours. Other constitutional and local symptoms improve as the fever goes down.
The rash fades in the order of its appearance, leaving a slight brownish stain which lasts for one or two weeks. Scaling begins as soon as the rash subsides and is completed in from a week to 10 days.
As the invasion or pre-eruptive stage of measles resembles the onset of other infections, or may in some instances be so mild as to arouse no suspicion, the true nature of the disease may be overlooked. The importance of early diagnosis is emphasized by the fact that the disease is perhaps most infectious during the first few days. The catarrhal symptoms are most marked before the rash appears.
In uncomplicated cases of measles, the fatality rate is low, perhaps one death for every 300 to 500 cases. Death is seldom due to the primary infective agent (virus) but to secondary invading organisms which attack the patient after his resistance has been lowered by measles. Germs of diphtheria and tuberculosis already in the body, or such dangerous newcomers as pneumococcus, streptococcus or staphylococcus may become active, involving eyes, ears, sinuses, lungs and the intestional tract.
Broncho-pneumonia is the most dangerous complication of measles. It develops in about 10 percent of cases and is the chief cause of death.
Mild laryngitis is an early symptom which usually subsides as the rash reaches full development. If laryngitis continues and becomes more aggravated the possibility of a complicating diphtheria must be considered. Otitis, or inflammation of the middle ear, occurs in about 12 percent of cases.
No specific treatment for measles is afforded. Treatment is directed at symptoms and with the thought of preventing complications. All suspected cases should be removed from contact with other children and put to bed if there is fever. A physician should be called immediately.
As the contagious material in measles is principally in discharges from the eyes, nose, throat and ears, linen soiled with secretions from these sources should be washed and sunned, otherwise disinfected or destroyed before other children come in contact with it. Clothing, mattresses and utensils used in the sick room should be thoroughly cleaned and well aired in the sunlight. The virus quickly dies under these conditions.
On the assumption that complications are apt to be less frequent and the outcome less serious as the child increases in age, parents should strive to defer the apparently inevitable attack of measles. Certainly there is no justification for the widely current belief that the earlier the child has the disese, the more easily immunity is acquired.
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