MASTOID DISEASE. See CEREBRAL ABSCESS, EXTERNA L EAR, and INTERNAL EAR.
MEASLES.—From an old English word meaning a spot.
Definition.—Measlcs—morbilli or ru bcola—is an acute, infectious, contagious disease generally met with in children.
Symptoms.—Afeasles runs a less vari able course, as a rule, than does scarlet fever and some other infectious diseases. Very mild cases sometimes occur, how ever, while the disease occasionally runs a very severe course. In rare instances a malignant type is encountered. Among 115 cases Carr found the average dura tion of the disease when uncomplicated to be twenty-six days from the prodromal symptoms to the end of desquamation. The period of incubation of measles is about twelve days.
Measles usually begins gradually, with feverishness, sneezing, coryza, suffusion of the eyes, and photophobia. Occasion ally a chill followed by a high temper ature is the initial symptom. 'Within twenty-four hours after the advent of the first symptoms a cough of pecnliarly hard dry character appears and the at tack presents all the symptoms of a catarrhal cold. The coryza, however, is more marked than that of an ordinary cold. The fever often falls somewhat after the first day; a fact which may throw the physician off his guard. The coryza and cough, however, do not cor respondingly diminish with the fall of the temperature, but usually increase. The eruption appears on the side of the face and is usually first seen on the after noon of the fourth day and is accom panied by increased fever. The eruption may appear as early as the second day, particularly in young children, and is, in rare instances, delayed to the fifth or sixth day. Drowsiness is not uncom mon during the stages of invasion, but there are no characteristic constitutional symptoms.
During the stage of invasion and be fore the anatomical changes are noticed on the surface of the body an eruption will be found upon the velum palati, which constitutes the surest sign of the affection. Tyler (Amer. Jour. of Obstet rics, Aug., 'SS).
The initial fever, or catarrhal stage, varies to an equal extent with the incu bation period; out of 193 cases in which this was noted, 12 had no premonitory, symptoms, the rash being the first sign of illness; 41 were affected only one day, 29 two days, 55 three days, 35 four days, and 21 from five days to a week before the eruption appeared. In one case there was a period of three days of giddiness, with a subnormal temperature, followed by a measles-rash. J. G. Carstairs (Aus tralian Med. Jour., July 16, '93).
Measles give rise to a mild pultaceo erythernatous stomatitis: this may pre cede exanthem, always accompanies it, and disappears with it. It is insidious and latent, and serves as means of diag nosis in doubtful cases (measles or ru beola). Comby (Le Bull. Med., Nov. 24, '95).
Measles may have a premonitory rash. These eruptions vary in character, being scarlatiniform, morbilliform, and erysi pelatous. They may even resemble red
miliaria. The erythemata generally ap pear about the second (lay of the period of invasion, and disappear before the measles eruption. Robet (Jour. de 1\16d., Sept. 10, '96).
Premonitory symptoms. A notable loss of weight occurs in many cases (Henri Meunier, 189S) in children in ap parent health. It begins on the third, fourth, or fifth day of incubation, and continues for six or seven days, with a normal temperature. A second sign consists in a great increase in the num ber of leucocytes, a day or two previous to any catarrh or other premonitory symptoms. During the period of erup tion the number of leucocytes falls very greatly below the normal. Combe sug gests that the uticro-organism of mea sles should be searehea for during the period of hyperleueoeytosis. Koplik's spots are not nearly so important an indication as an erythemato-pultaceous stomatitis of the cheek-s and gums (Comby), which consists of redness and swelling of the mucous membrane of the gums and inside of the cheeks, which are covered with a pale, opalescent, easily detached, whitish, epithelial coat ing. It precedes the eruption very often, and is then a trustworthy premonitory sign. While all these signs have a cer tain diagnostic value, none of them can be absolutely relied upon. Guinon (Bev. Mens. des Mal. de l'Enf., Apr., 1901).
Epidemic of measles in which a pul taceous angina developed from two to seven days before the measles in 15 eases out of 100 seen. Sint:.11, white, isolated, bluish-white spots also ap peared on the roof of the palate with Koplik's sign, fever, and dysphagia. In some of the cases diphtheria baedli were found in the throats. Saint-Philippe (Jour. de Ated. de Bordeaux, Apr. 7, 1901).
Koplik has recently described a symp tom which he believes to be of great value in making an early diagnosis of measles. On the first day of invasion he has found that an examination of the buccal mucous membrane in a good light will reveal a scattered eruption consist ing of small, irregular spots of bright red color, in the centre of each of which is a minute bluish-white speck. This he regarded as pathognomonic of measles. Carr and other writers have recently ex pressed a belief in this symptom.
Diagnostic importance of the bluish white spots upon the mucosa of the cheeks, signalized by Eoplik as a con stant phenomenon of the period of in •t , (—mauled by the examination• • —it rbt us at lents. Libman Oled.
- lute 11, 'tts, h •i..:11 noted in all of ti7) casesf ts • in tthith it had bt•tm looked r it. • t tilt. stages. Looked for in I I t 11,1111i14. bronchitis. riltheln,tii lashes. erythema multifornie, ..r t t, %OM ftWer, pityriasis, eczema, t' • an impetigo, it was invariably il• tIttl Eveord, June 3. ';') I •t important signs during the