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the invasion stage, which ushers in the early clinical symptoms,
viz., the characteristic coryza or catarrhal symptoms, cough,
sneezing and watering of the eyes, popularly known as "running
from the eyes and nose." This stage lasts 4 days (and it is
during this stage that the disease is so rapidly spread), and ends
with the appearance of the well-known Measles rash, commencing
first on the face, pinky-red in colour, raised and erescentic in
outline. The rash persists for 3 or 4 days, and then dies away,
followed by a branny shredding of the surface of the skin, the
patient becoming convalescent a fortnight after the appearance
of the rash.
The disease is most highly infectious during the invasion
stage, i.e., the period between the onset of the first symptoms
and the appearance of the rash, usually 4 days, and is spread
mainly by the sprayed droplets expelled by the coughing and
sneezing of the patieftt of the secretions from the eyes, nose and
throat. The disease may be spread by other agencies, e.g.,
clothing, &c., but there is very little proof of these modes of
infection, nor are they important, as in the vast majority of cases
the disease is spread by direct contact by patients suffering from
the catarrhal stage.
Mortality from Measles.
Measles is essentially a disease of childhood, and is
undoubtedly the most serious menace to child life. In London
the total deaths from Measles exceed those from all the acute
infectious diseases. In the five years 1905-1909 Measles was
responsible in London for the deaths of 9,301 persons, as compared
with 8,585 deaths from all the compulsorily notifiable
diseases (viz., Small-pox, Scarlet Fever, Diphtheria, Enteric
Fever, &c.) ; 7,601 of these London deaths from Measles occurred
in the first three years of life, viz., 2,049 in the first, 3,988 in
the second, and 1,573 in the third year of life. In the Borough
of Battersea during the period 1903-12, Measles caused 777
deaths, as compared with 549 deaths from the compulsorily notifiable
diseases. The disease is peculiarly fatal to very young
children, no less than 741 of these 777 deaths occurring amongst
children under 5 years.
Fatality.
The fatality-rate, or case-mortality as it is called, i.e., the
percentage of deaths amongst persons attacked is, owing to the
absence of a compulsory system of notification, impossible to
obtain. In Edinburgh, where the disease is notifiable, the
annual fatality-rate varied from 5"9 per cent, to 1.5 per cent,
over a period of ten years, the average being 3.1 per cent., and
this average has been confirmed by the experience of other
investigators.