MEASLES.
Measles is an extremely infectious disease, before as well as after the rash appears on the fourth day of the disease. The infectivity of the catarrhal stage constitutes one of the main difficulties in preventing its spread, as measles may be unrecognisable at this stage. The common notion that measles and whooping-cough are comparatively harmless infantile complaints will be dissipated by a study of the comparative death-rate for the five years 1891-5 per million persons living in England and Wales:—
England and Wales.—Death Rates per Million of Population.
| Small-pox | 20 |
| Measles | 408 |
| Scarlet fever | 183 |
| Typhus fever | 4 |
| Enteric fever | 174 |
| Whooping-cough | 398 |
| Diphtheria | 253 |
| Diarrhœa | 630 |
It is a mistake also to suppose that measles and whooping-cough are only serious when neglected. Such neglect greatly increases the likelihood of death from bronchitis or pneumonia; but the diseases themselves, especially measles, are frequently fatal during the acute early stage. More children are attacked with measles under the age of five than at any other age, and the greatest number between two and four years of age. The greatest fatality is in the second year of life, when it may be 24 per cent. of those attacked, as compared with between two and three per cent. in the fourth year of life, and a trifling amount at higher ages. These facts explain the folly of allowing children to have an infectious complaint when another child in the house is attacked, “to have it over at one trouble.” Such action is pregnant with evil results. (1st) Severe cases occur, in which a fatal result ensues; and even where death does not occur, the child may be left weakly and very prone to become tuberculous. (2nd) Every additional case forms a new centre of infection. It is like the old practice of inoculation for small-pox; the individual is protected, but becomes a source of danger to all around him. If there is only one case of measles in a family the risk to neighbouring households is much smaller than where several children are infected. (3rd) Every year that a child’s attack can be delayed, increases his chance of recovery if he is subsequently attacked, and diminishes the likelihood of his being attacked.
The duration of infection should be reckoned as at least three weeks. The contagium of measles does not appear to hang about rooms with the persistence of that of scarlet fever, and less stringent disinfection is required.
WHOOPING COUGH.
Very few people have reached adult life without having suffered from this disease, as well as measles. This is chiefly due to the carelessness in mixing infected with healthy children. One frequently hears the peculiar and characteristic cough of a child with whooping-cough, in public assemblies, in railway trains, or in the out-patient rooms of hospitals. The contagium of whooping-cough is conveyed chiefly by the expectoration, which becoming dry, may be scattered like that of phthisis, as dust. Clothing conveys infection easily; visits to infected children should, therefore, be prohibited to all who have to mix with susceptible children.
The duration of infection should be reckoned as at least six weeks from the first recognisable symptoms. It may be longer than this.