658 MEASLES ailment, it cannot safely be regarded with indifference. Indeed it is doubtful whether any other disease of early life demands more careful watching as to its influence on the health. Happily many of those attending evils now alluded to may by proper management be averted. Measles is a disease of the earlier years of childhood. Like other infectious maladies, it is admittedly rare, though not unknown, in nurslings or infants under six months old. It is comparatively seldom met with in adults, but this is simply due to the fact that most persons have undergone an attack in early life, since, where this has not been the case, the old suffer equally with the young. All races of men appear liable to this disease, provided that which con stitutes the essential factor in its origin and spread exists, namely, contagion. Some countries enjoy long immunity from outbreaks of measles, but it has frequently been found in such cases that when the contagion has once been introduced the disease extends with great rapidity and virulence. This was shown in two well-known in stances in recent times, namely, the epidemic in the Faroe Islands in 1846, where, within six months after the arrival of a single case of measles, more than three-fourths of the entire population were attacked and many perished; and the similarly produced and still more destructive out break in Fiji in 1875, in which it was estimated that about one-fourth of the inhabitants were cut off by the disease within a period of about three months (see FIJI). In both these cases the great mortality has been ascribed to the complications of the malady, specially induced by over-crowding, by insanitary surroundings, the absence of proper nourishment and nursing for the sick, and the utter prostration and terror of the people, rather than to any marked malignancy in the type of the disease. 1 Not a few authorities, however, while fully recognizing the baneful effect of these unfavourable conditions, are yet dis posed to hold that epidemics of this kind, when occurring in what might be termed a virgin soil, are apt to possess an innate severity. In many lands, such as the United King dom, measles is rarely absent, especially from large centres of population, where sporadic cases are found in greater or less number at all seasons. Every now and then epidemics arise from the extension of the disease among those members of a community who have not been in some measure protected by a previous attack. There are few diseases so contagious as measles, and its rapid spread in epidemic outbreaks is no doubt due to the well-ascertained fact that contagion is most potent in the earlier stages, even before its real nature has been evinced by the characteristic appearances on the skin. Hence the difficulty of timely isolation, and the readiness with which the disease is spread in schools and families. There is little doubt too that the contagion may be carried from one place to another by persons themselves unaffected, as well as by clothing, &c., although its tenacity and activity in this respect is apparently much less marked than that of small-pox or scarlet fever. Of the nature of the infecting agent nothing certain is known. Kecent investigations into the mode of origin of others of the acute infectious diseases, and the discovery in the blood and tissues in the case of some of them of lower forms of organic life (bacilli), which can be isolated and can by inoculation be made to communicate the particular malady to which they are related, give countenance to the opinion, now widely entertained, that the infecting principle of the exanthemata is of this nature. The subject, however, is still under investigation, and more information is wanting before definite statements can be made. Second attacks of measles are occasionally observed, but they are rare. Transactions of the Epidemiological Society, London, 1877. Treatment. The treatment of measles embraces the preventive measures to be adopted in the case of an outbreak by the isolation of the sick at as early a period as possible. Epidemics have often, especially in limited localities, been curtailed by such a precaution. In families with little house accommodation this measure is frequently, for the reason already referred to regarding the communic able period of the disease, ineffectual; nevertheless where practicable it ought to be tried, for it is a grave error needlessly to expose the healthy children in a family to the risk of infection under the idea that they must necessarily take the disease at some time or other. The unaffected children should likewise be kept from school for a time (probably about three weeks from the outbreak in the family would suffice if no other case occur in the interval), and all clothing in contact with the patient should be subjected to disinfection or thorough washing. In extensive epidemics it is often desirable to close the schools of a locality for a time. As regards special treat ment, in an ordinary case of measles little is required beyond what is necessary in febrile conditions generally, Confinement to bed in a somewhat darkened room, into which, however, air is freely admitted in such a manner as to avoid the risk of draughts, light nourishing liquid diet (soups, milk, &c.), and mild diaphoretic remedies such as the acetate of ammonia or ipecacuanha, are all that is necessary in the febrile stage. When the catarrhal symptoms are very severe, the hot bath or warm packing to the body generally or to the chest and throat afford relief, and the same measures may with advantage be adopted should the eruption be but feebly developed or tend to recede, and especially should convulsions set in. The serious chest complications of measles are to be dealt with by those measures applicable for the relief of the particular symptoms (see BRONCHITIS, PNEUMONIA). The inhalation of vapour and the use of the preparations of ammonia are of special efficacy. Diarrhoea is treated by the usual remedies, including carefully administered doses of Dover s powder, chalk, &c. During convalescence the patient must be guarded from exposure to cold, and for a time after recovery the state of the health ought to be watched with the view of averting the evils, both local and constitutional, which but too often follow this disease. = German Measles (Rotheln, or Epidemic Roseola] is a term applied to a contagious eruptive disorder having certain points of resemblance to measles, and, according to some observers, also to scarlet fever, but exhibiting its distinct individuality in the fact that it protects from neither of these diseases. It occurs most commonly in children, and is occasionally seen in extensive epidemics. Beyond con finement to the house in the eruptive stage, which, from the slight symptoms experienced, is often difficult of accomplishment, no special treatment is called for. There is little doubt that the disease is often mistaken for true measles, and many of the alleged second attacks of the latter malady are probably cases of rotheln. The chief points of difference are the following : 1. The absence of distinct premonitory symptoms, the stage of invasion, which in measles is usually of four days _duration, and accompanied with well-marked fever and catarrh, being in rotheln either wholly absent or exceedingly slight, enduring only for one day. 2. The eruption of rotheln, which, although as regards its locality and manner of progress similar to measles, differs somewhat in its appearance, the spots being of smaller size, paler colour, and with less tendency to grouping in crescentic patches. The rash attains its maximum in about one day, and quickly disappears. There is no accompanying increase of temperature in this stage as in measles. C. The milder character of the symptoms of rotheln throughout its whole course, and the absence of complications and of liability to subsequent impairment of health such as have been seen to appertain
to measles. (J. 0. A.)