MEASLES, SCARLET FEVER, MUMPS, DENGUE FEVER, ETC. 925 



likely that infection from secretions on toys, food or other objects that 

 are put into the mouth may take place, so long as the secretion is not 

 dried. Judging from what we know or other filtrable virus, more- 

 over, the virus of measles may offer considerable resistance even to 

 drying. 



One of the most important epidemiological facts is the infectious- 

 ness of the secretions in the early pre-emptive stages. According to 

 Levy of Richmond, the disease may be infectious as long as 4 days 

 before the rash appears and since at this time the patients are rarely 

 very sick, this is the dangerous period for transmission. 



Uncomplicated measles in itself is not a very fatal disease, but, 

 like influenza, measles seems to bring about a certain susceptibility to 

 various respiratory infections, and measles epidemics are usually ac- 

 companied by many fatal post-measles pneumonias. These pneu- 

 monias may take the form of pneumococcus or streptococcus infec- 

 tions, according to the nature of the most prevalent mouth and throat 

 flora prevailing in the community. The conditions for a fatal measles 

 epidemic, therefore, are fulfilled when measles breaks out in an indus- 

 trial community, a camp, a school, etc., during the cold weather when 

 coughs and colds prevail and when virulent pneumococci and strep- 

 tococci are plentifully scattered about in mucus. 



The prevention of measles, in crowded communities or groups, is 

 fraught with many difficulties. However, with vigilance and adequate 

 discipline, much can be accomplished. In schools, industrial commu- 

 nities and in military units, the most important procedure in our 

 opinion is constant inspection and early segregation of all individuals 

 with catarrhal colds. In the army it has been the practice of sani- 

 tarians, a practice which we believe we have seen succeed to an un- 

 expected degree, to inspect entire units once a day upon the appear- 

 ance of a case of measles. The entire unit is made to pass an in- 

 specting officer in single file in the morning, a few questions *as to 

 general health are asked, the conjunctive and throats and the skin 

 of the chest and arms are rapidly inspected, and individuals 

 complaining of headache, a restless night, a cold or a cough, or those 

 in whom the conjunctivas are inflamed, or the nose secreting, are 

 made to step out and, on these, temperatures are taken. All those 

 with a temperature of 100 or above are isolated and great care is 

 taken to segregate catarrhal cases from the rest of the population. 

 This method makes it possible to inspect a large group in a very short 

 time and will accomplish far greater results than the mere isolation 



