breath. After an attack of measles personal infection is probably over by the end of the month; it may persist longer, or be conveyed somehow by convalescents for another month. How long infection may cling to articles of clothing, or linger in closed rooms, is uncertain. On the fourth day of the initial fever the eruption appears and continues four days."

Wood's Reference Hand Book states: "Although the nature of the disease may be conjectured during the prodromal stage, it is only during the eruptive stage that the diagnosis of measles can be definitely determined. The danger of contagion is proportionate to the propinquity of the contaminating influence, being greatest in the sickroom. It cannot be denied that measles may be spread by mediate contagion. In such cases the clothing probably becomes the disseminating agent. Except

small-pox, measles is probably the most contagious of the exanthemata and is communicable from the early prodromal stage until desquamation is completed. The infectious properties are probably most active during the prodromal stage. The great difficulty of identifying measles during this stage in a great measure explains the rapid dissemination of the disease in schools, asylums, etc. The contagious properties continue throughout the stage of eruption, but speedily diminish with it and probably become extinct during desquamation."

I. N. Brainerd, M. D., of Alma, Mich., in a letter to this office bearing on this subject, dated March 8, 1890, states :1 "Dr. Hardaway, professor of diseases of the skin in the St. Louis Post-Graduate School of Medicine and in the Missouri Medical College, St. Louis, and president of the American Dermatological Association, says: Various circumstances render it probable that measles is most readily propagated during the stage of efflorescence.2 This being

1 Report Michigan State Board of Health.
2Pepper's System of Medicine, Vol. 1, p. 560.

the case, the most infectious stage of the disease is not passed before the disease can be recognized and notice of its presence be given. It is true that measles is communicable during the four days of prodromal fever, during the five days of efflorescence, and during the five days (about) of exfoliation. Conceding that we can offer no protection during the first four days, shall we therefore offer no protection during the remaining ten days? . . . Hardway says: Leaving out of account sucklings under six months of age, in whom measles is rare and said to be slight, most deaths from the disease (measles) occur among very young children, from the greater liability to complications. According to Beddoes, the mortality from measles is, beyond all comparison, greatest in the second year of life.'1 Vital Statistics of Michigan, 1885, says (p. 221) that 84.22 per cent. of the deaths from measles in that year occurred in children under five years of age, and that only 2.63 were above twenty years of age."

Quain's Dictionary states: "The annual mortality from measles in London is nearly five per ten thousand." In Michigan the reported deaths from measles for the twelve years, 1876-1887, average 146 per year. If we assume that only three fourths of the deaths were reported, the deaths in Michigan from measles have been about two hundred per year.

The report of the Iowa State Board of Health, in discussing this subject, says: "Measles is one of the most common diseases with which the human family is afflicted. So common is it, attacking young and old alike, if exposed, and if not protected by a previous attack, that people have come to regard it as one of the unavoidable dispensations of Providence. The idea obtains almost everywhere that there is no use to try to avoid it-that everybody must have the disease at some time, and it is better to have it in childhood than in adult life."

1Pepper, Vol. 1, p. 578.

There is a terrible mistake here. It is a wholly unnecessary disease. It exists only because of a settled belief in the opinions stated above in regard to the inability to avoid it.

It is a purely contagious disease. If there was not a single case in the United States for six months, there never would be another one unless brought in from abroad. It is possible, by isolation and disinfection to stamp out the disease. If, through the carelessness of others, it comes into any community, it can, by appropriate means, be restricted to the family where it first makes its appearance.

Measles is not regarded as a very serious affection, and yet, taking the whole state, the number who die or are disabled annually, is very great. Many who do not die, only partially recover. Permanent injury to the eyes or ears, or pulmonary diseases, often result therefrom. Those who have the disease in their family, and have them all recover without serious complications, congratulate themselves, not only on escaping so well, but because they had the disease and are done with it. The neighbor living near by, whose children contracted the disease from exposure to those who have recovered, may not fare so well. One or two may die or may be disabled for life. They will forever regret that the unnecessary importation of the disease was ever made into the community. It is as pre

ventable a disease as small-pox, and there is no more excuse for its existence and spread than there is for smallpox. When a case occurs in any locality it is because some one has done a great wrong. If transplanted to any community, and it is allowed to become epidemic, a greater wrong is committed. It would save the state thousands of dollars annually, to say nothing of the loss of precious lives, and the entailment of useless grief, if the people generally would appreciate the fact that the disease is an imposition, and would act accordingly.

Statistics furnished by the Michigan State Board of

Health show that over seventy-one per cent. of all deaths from measles in the state were of children under five years of age, while but little over eight per cent. were of persons from ten to twenty years. The same percentage of deaths doubtless occurs in Iowa. It is therefore important to restrict the disease, and especially so that it shall not reach those in the second and third year of life.

The Iowa State Board of Health recognizes measles as a contagious and infectious disease. It should, therefore, be subjected to the same regulations, as to isolation and disinfection, as scarlet-fever and diphtheria.

Whenever a health officer of a local board has reason to believe that there is a case of measles within his jurisdiction, he should,

1. Promptly investigate the subject.

2. Order prompt and thorough isolation of those sick or infected with measles.

3. See that no person suffers from lack of nurses or supplies.

4. Give public notice of infected places.

5. Notify superintendents or teachers of public schools, of families in which measles prevail.

6 Supervise funerals of persons dead from measles, and see that no public funeral is had.

7. Supervise the disinfection of rooms, clothing, and premises, and all articles likely to be infected, before allowing them to be used by other persons than those in isolation.

Every person recovering from measles, whether the form is mild or malignant, should be considered dangerous, and should not be permitted to mingle with others, nor attend school, church, or any public assembly, until, with the approval of the attending physician and the local board of health, he can do so without endangering others. Nor should any person from premises where there is or has been a case of measles, be permitted to attend public

school, church, Sunday school, or public assembly, until after a proper disinfection of the premises, and the clothing of such persons, if it has been exposed, has been had. To avoid measles, keep away from it.

Do not let a child, especially between one and two years of age, go near a case of measles.

Do not permit a person, dog, or cat, or other animal, or a thing to come direct from a case of measles to a child.

Do not permit a child to wear or handle any article of clothing that has been worn by another during sickness or convalescence from measles.

Do not permit a child to ride in a hack or a closed carriage in which has been a person sick with measles, except the vehicle has been thoroughly fumigated with burning sulphur.

Unless your services are actually needed, keep away from measles.

Do not permit a child to kiss a person who has a cough or sore throat; nor take the breath of such person; nor drink from the same cup, blow the same whistle, chew the same gum, or put his pen or pencil in his mouth.

Beware of any person who has a cough or sore throat. School teachers should be especially prohibited from going near measles, and this rule should be enforced by school boards and local boards of health.

Where there is complete isolation of the sick, and no communication whatever had with other persons, except the physician and nurse, other adult members of the family can safely go about their usual vocations, avoiding children and public gatherings. This exception will not apply to school teachers who may be living where there is measles. Such should leave the school, or change their residence.

Local boards of health are instructed to enforce the regulations upon the placard and are empowered to exact any additional precautions that the conditions and exigencies may seem to require.