REMARKS UPON THE STAGES OF INFECTIVENESS OF MEASLES.

Thursday, 24th of December 2015

REMARKS UPON THE STAGES OF INFECTIVENESS OF MEASLES.

By T. FREDERICK PEARSE M.D. LIPHOOK HANTS.

The following cases are particularly instructive as well as interesting from the exact as well as reliable data which were able to be obtained. Two brothers. C. and H. returned home for their holidays on Friday April 2Ist. Exactly a week before they "broke up" a boy returned to school from the Isle of Wight where he had been about a fortnight for a change after an attack of measles. The convalescent was a day boarder but played about with the other boys and is said to have been wearing the same clothes in which he went away ill. A few days before the "break up" another boy was separated from the rest of the school with a so-called "cold". Three days after the return home of the two (brothers viz. on Monday April 24th the eldest of the two was taken poorly but with no very definite symptoms beyond those of a "cold until Friday the 28th. On the afternoon of that day his face was noticed to be blotchy" and he showed a few red spots about the neck. There being a younger son at home who had not been to school on account of his health the parents promptly separated him from his two brothers to another part of the house. Up to this time the second boy who had been to school appeared quite well. A rash however of an unmistakable character was recognized on the following day (29th). These two boys passed through a typical though favorable attack of measles. The crisis in each case occurred on the night of the sixth day of the disease; and after the rash had been visible- Oct. 7 for forty-eight hours-the temperature falling from 102.8° to 100.6° in the case of the eldest boy and from 103.2° to 98.40 in that of the second son. The case of the eldest boy seemed to be about twelve hours earlier than that of his brother. Meanwhile the youngest son who had been separated at a different part of the house continued in his usual health and was sent away on Tuesday May 2nd to Brighton. The other two boys continued to progress very favorably. It is now that the chief feature in these cases presents itself. On Saturday May 6th the youngest son who had been sent away to Brighton was attacked with symptoms of a cold and cough associated with loss of appetite and feverishness. He was fetched home on the following day. On the 8th his temperature was 101.40 with the above symptoms more marked and a rash of a "pimply" character on the back of the neck. During the night of the 10th a marked rash having all the characters of true measles and resembling that of the other two sons was developed with delirium diarrhea and oppressed breathing. The next morning his temperature was I03°. He has since passed through the attack but at one time showed threatening symptoms from the character of his breathing. Upon the infectiveness of measles Niemeyer says "When is measles infectious? With our present knowledge we should say it is most infectious while the eruption is out; that it is probably not infectious in the stage of desquamation while numerous cases speak of its being so in the prodromal stage. The popular opinion that measles is most catching in the desquamative stage arises from inattention to the period of incubation. A child infected by its brother or sister breaks out with the disease while the latter is desquamating it is true but was infected while the exanthema was at its height or perhaps even before the eruption. The probability of infection during the prodromal stage is supplied by the wonderful spread of measles through schools. Great care is usually taken to keep out of the school any children who have not passed through the desquamative stage as well as those having any suspicious exanthema but children with catarrh and cough are allowed to sit on the seat with well children." The data of my cases are sufficiently accurate to prove-First. That measles is infectious when the stage of desquamation has apparently passed (the two eldest boys having caught the disease from a boy who had measles more than a fortnight before). Secondly. That measles is infectious before the rash appears (the third boy having been separated from his brothers directly the rash was observed on the face of his eldest brother). Thirdly. That the period of incubation of measles is about ten days. This was exactly the time which elapsed between the return of the convalescent to the school and the first symptoms in the eldest boy and it was rather less than that period which elapsed between the separation of the eldest and youngest boy and the development of undoubted symptoms in the latter. This last calculation (see dates) suggests that the youngest boy caught the disease from his eldest brother the day before the appearance of any rash. If these opinions should prove to be true the difficulties in arresting an epidemic of measles will be unusually great. The last conclusion is a point upon which the attention of medical officers of health might be more particularly directed. Other questions also suggest themselves from a consideration of these cases. Do infectious diseases differ in their character or severity according to the stage of the disease in which the infection is propagated? Is measles when caught during the prodromal stage more severe than when propagated at another period? Do the investigations of Pasteur suggest that there may be a difference in this respect? The treatment adopted in the above cases consisted in the strict use of disinfectants-carbolic acid being used about the room and for a suspended sheet at each doorway-and a solation of thymol for sponging the body night and morning. Internally sulphite of soda in ten grain doses was given thrice daily.