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.[pg 004] 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.