MEASLES. Definition, Cause, etc.-An acute febrile disorder characterized by the occurrence of coryza and an eruption upon the skin of small red papules that ultimately coalesce into irregularly round or crescentic blotches. Measles is one of the most, if not the most, contagious of the acute exanthemata. Its cause has not yet been determined. It is a disease of the first five years of childhood, though it is also occasionally observed in adults (see Table II.; see also page 28). The rarity of measles in adults is probably to be explained through the fact that practically all children pass through the disease, and one attack usually protects against subsequent infection, though this is not always the case, as instances are recorded in which more than one occurrence of the disease has been observed in the same individual. It is endemic in all civilized countries, and occasionally breaks out in epidemic form. It is a disease of late autumn and early spring. It is directly communicable from the sick to the well; the secretions from the catarrhal surfaces and the exfoliated epidermis are capable of infection, and the disease may be carried by fomites and by persons. As in the case of varicella, vigorous efforts are rarely made to prevent the spread of measles. It is so eminently contagious that the usual efforts are considered of but little avail. The patient should be isolated, and only the nurse and physician should have access to the sick-room. The napkins, towels, dishes, bed- and body-clothing should be disinfected before they are permitted to be taken from the room. After recovery the room should be thoroughly disinfected and cleaned, and well aired. Rubeola (Rötheln or German measles) partakes of certain of the characteristics of both measles and scarlatina, though immunity to it is not conferred by an attack of either of these diseases. Its cause is not known. It is considered a distinct, specific, febrile disorder. It is characterized by an eruption. It is communicable by direct contact between the sick and the well. It is less contagious than measles. It is more common in youth than in childhood. It often occurs in epidemic form. In other respects, what has been said for measles applies also to rubeola, except perhaps that its spread is more readily controlled than is that of measles. SCARLET FEVER. Definition, Cause, etc.-An acute, specific fever characterized by the occurrence of erythematous rash upon the skin, and accompanied by angina of varying degrees of severity. Its cause is not known. The various bacteria and protozoa that have been described as occurring in these cases have not been proved to stand in causal relation to them. Because of the constant presence of streptococci in the angina that is associated with scarlatina, and because of the occasional detection of this organism in the internal viscera as well, it is held by some that the streptococcus found stands in causal relation to the malady. This opinion is not, however, generally accepted, principally for the reasons that the streptococci discovered do not differ from the ordinary pyogenic streptococcus, and that the disease is in all respects different from the usual results of infection by this organism. It has been suggested that the clinical manifestations of the disease as well as the anatomical lesions, except those in the throat, are the result of absorption of toxins produced by the streptococci located in the diseased tonsils, and that the disease is not necessarily a result of general systemic infection; this view also is not generally accepted. In the present state of our knowledge it can only be said that the exciting cause of scarlet fever is as yet unknown, and that up to date there have not been any suggestions upon this point that have met with general acceptance. It is contagious, though less so than measles. It occurs both sporadically and as epidemic outbreaks. Though a disease of childhood, it is much less common in children under 1 year of age than among those between 2 and 10 years old. It is also occasionally encountered in adults. TABLE XIV. Scarlatina at the Hospitals of the Metropolitan Asylum's Board, London. Arranged according to ages (Goodall and Washbourn1): See Tables II. and III., also paragraph on Age, page 28. It is a disease of autumn and winter (see diagram in Section I., under the heading of Predisposing Influence of Season). It is known among all peoples in all countries. In mild outbreaks the fatality varies from 4.2 to 10 per cent., while in severe epidemics it often reaches 15 and 20 per cent. of those affected. Dissemination.-Scarlet fever is probably contagious at all periods, but it appears to be especially so during the stage of desquamation. The morbific agent, whatever it may be, is very tenacious of life and pathogenic powers, and may cling to clothing, furniture, and the like for very long periods, retaining its power to reproduce the disease under favorable circumstances. Physicians, nurses and attendants, members of the family, and fomites may carry the disease. Contagion may also occur directly through the air of the sick-room, and this is perhaps the commonest mode of transmission, especially when the air is laden with the fine dust-like particles of epidermis shed by 1 Infectious Diseases, by Goodall and Washbourn, Philadelphia, 1896. the patient during the stage of desquamation. In the earliest stages-i. c., before the development of the eruption-it seems to be less contagious than later. There is no evidence that the disease is conveyed by water. There are a number of instances in which it has been carried and more or less widely disseminated by infected milk. By some writers the milk of cows affected with streptococcus inflammation of the udder is believed to be capable of causing the disease in human beings who use it. The angina of scarlet fever, when uncomplicated by dipntheria, is caused by the ordinary streptococcus pyogenes; at least this pathogenic species is so constantly present in the condition, and in such numbers and often unassociated with other disease-producing bacteria, that this opinion is reasonably justifiable. Diphtheria may be engrafted upon scarlatina, in which event bacillus diphtheria is found in the fauces, usually associated with streptococci. The angina of uncomplicated scarlatina is not, therefore, etiologically identical with the pseudomembranous inflammation of the fauces that characterizes true diphtheria, though both clinically and anatomically it may present a number of · features in common with it. Prophylaxis.-The patient should be isolated in a room as scantily and simply furnished as circumstances will permit. The accompanying diagram illustrates what has been done. in Michigan by enforced isolation of cases of both scarlatina and diphtheria (Chart 20). Because of the case with which the disease may be carried, only the physician, nurse, or immediate attendant should have access to the room; and because of the tenacity to life possessed by the scarlatina virus, great care should be given to the disinfection (by boiling water, carbolic-acid solution or chlorid-of-lime solution) of all articles before they are permitted to leave the room. The entire surface of the body of the patient should be kept anointed with an antiseptic oil or ointment to prevent the escape of particles of epidermis into the air. These pre |