Apart from the traeheobronchitis which commonly occurs and may he of a more or less severe type, involvement of the lungs is the most serious complication. Capillary bronchitis or bronchopneumonia occur comparatively frequently in the first year of life. Objectively they are evidenced by a sharp rise in temperature to 40° C. (104° F.) or higher, passing into a continuous form of fever, also by rapid breathing, dyspncea and increasing unrest. Physical examination of the chest confirms this. Frequently the disease is bilateral, and the area of pneumonia is diffi cult to localize, especially when it is centrally situated; small foci, espe cially early in the disease, can readily be overlooked, particularly when there exists at the same time a generalized bronchitis of the smaller tubes, the latter not. uncommonly causing atelectasis in Young children by reason of the lessened entrance of air into the lungs. Capillary bronchitis and a spreading croupous pneumonia in the course of measles are most unfavorable complications.
In cases that recover, after the disappearance of the fever and the other acute manifestations, it generally requires several weeks before the normal note is found over the situation of the consolidation, the auscultatory signs of consolidation disappear somewhat earlier. On account of their slow disappearance Escherich terms these "a-sthenic pneumonia." They frequently raise a question as to the existence of tuberculous infiltration, from which however they are differentiated mainly by their further course.
In persons with latent tuberculosis, particularly of the bronchial lymph-nodes, a more or less widespread tuberculosis of the lungs may develop with measles. This may take the form of a local infiltration or a miliary tuberculosis with a marked rise of temperature.
There is still to be mentioned the acute necrotic pneumonia de scribed by Heubner. In this the measles virus brings about an acute necrosis of the lung tissue and in the course of a few weeks the produc tion of extensive bronchiectases. The rash is usually of a fleeting nature, fading rapidly and coming on long after the prodromal signs, and only shortly before death.
The peculiar course of the measles rash as well as the acute pul monary complications may here be described in detail.
Among the laity these rudimentary forms are spoken of as "measles striking inward." After the appearance of such a rash, lung complica tions can safely be surmised. The rash shows a pale or bluish discolora tion passing into a deep cyanotic appearance (with luemorrhagic mea sles the coloration is brownish and livid). The mucous membrane of the lips, mouth and conjunctivze are blue. The anxious expression, the
movements of the ape nisi and other signs of dyspnwa, the great rest lessness, and collapse, complete the picture. it is mostly in children in the first year of life that. these most severe and fatal forms are observed.
Frequently the lung affection in measles is brought about by a mixed infection with influenza. In the majority of systematic investi gations carried out upon such forms of pneumonia, the influenza bacillus was found in the bronchial secretions. Whooping-cough which readily appears in association with measles, likewise gives rise to acute and chronic lung affections. especially in tuberculous subjects. They may also favor the outbreak of pleurisy, which is mostly of the fibrinous variety, but may also be serous or purulent.
The heart is seldom affected in measles. Frequently during the most severe period of fever a faint murmur may be heard for a day or two, without further injury being discoverable. The endocardium, myocardium, and pericardium each may suffer. As a result of measles rapid and failing heart action may arise, and myocardial changes are the features that remain, and by their severity impair greatly the general condition.
A transient albumin uria may occur during the febrile period without further injury to the kidney. Sometimes there is a nephritis analogous to that seen in scarlet fever. As to causation these cases of nephritis appear to be of infective origin, and not infrequently the assertion has been made that they are produced by the virus of measles, thus far however they have not been submitted to systematic pathological investigation.
In measles the frequent diazo reaction in the urine is an evidence, as in typhoid fever and tuberculosis, of an increased destruction of the albuminous bodies, and of a disturbance of tissue change.
The eyes, which suffer an acute conjunctivitis in the early stages show in the later course of the disease a tendency to chronic conjuncti vitis and blepharitis. This is especially so in children of a scrofulous tendency or as the result of neglect. The conjunctivitis can proceed to the development of phlyctenules and finally to ulceration with marked photophobia and lachrymation and as a result, an extensive eczema of the face may be produced. The. swelling of the conjunctiva and lids may continue with intense purulent discharge, in the further course of which I have observed one case of bilateral panoplithalmitis which apparently had its origin in infective embolism, or in infection from without, the bacteria gaining entrance through an already poorly nourished cornea.