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rash, temperature, children, disease, time, patient, evening, catarrhal and bodies

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MEASLES (rubeola or morbili) is one of the commonest infectious fevers to which children are liable ; and few persons arrive at adult years without having suffered from an attack. It affects children of all ages, and is far from uncommon in infants. Scattered cases of measles may be found almost at any time in large towns, but at certain periods of the year the complaint becomes epidemic. These epidemics vary curiously in severity and in the predominance of particular symptoms. One may be signalized by a high percentage of mortality. In another vomiting may be a prominent and distressing feature. In a third the catarrhal phenomena may be unusually slight ; or again, they may be severe out of all proportion to the intensity of the rash. 'When fatal, measles is so generally through its com plications. It rarely kills by the intensity of the general disease. Still, in some cases we meet with epidemics in which the disease tends to assume an asthenic, type. In these the mortality is high. The fatal cases are marked by early and extreme prostration. The patient seems overwhelmed by the violence of the attack, and dies before any complication has had time to manifest itself. As a rule, one attack protects against a second, but cases where the disease has occurred two and even three times are not un common.

The contagious principle of measles is apparently communicated by means of the breath. It is said to be volatile, and to be capable of adher ing to clothing. According, to Meyer, it is easily removed, as the mere airing of clothes is sufficient to disinfect them. Messrs. Braidwood and Vacher have examined the expired air of measles patients 'by making them breathe through glass tubes coated 'in the interior with glycerine. On examination afterwards with the microscope, the glycerine showed in every case numerous sparkling colourless bodies, some spherical, others more elongated with sharpened ends. They were most abundant during the first and second days of the eruption. As a negative test, the breath from healthy children, and children suffering from scarlatina and typhus, was also examined, but without any result.

The infection of measles begins at the very beginning of the catarrhal stage, and lasts for some time after the rash has faded. Dr. Squire is of opinion that three weeks ought to elapse before the patient can be con sidered free from all chance of communicating the disease.

Morbid Anatomy.—The post-mortem appearances in cases of death from this complaint are those of the complication to which the fatal termination is owing. In cases where the child has died early from the severity of the disease, little is found except that the blood is dark coloured, deficient in fibrine, and coagulates imperfectly. There is also hypostatic congestion of

the lungs and hyperEemia of the mucous membranes and organs generally, with extravasation into their substance. The spleen and lymphatic glands are often swollen. Sections of the skin made on the sixth day of the erup tion were examined by Messrs. Braidwood. and Vacher. There was swelling of the corium, and thickening of the rete lklalpighii from great proliferation of cells, which extended along the hair and sweat-ducts into the glands. Sparkling, colourless, spheroidal, and elongated bodies, similar to those discovered in the breath, were found in the portion of the true skin lying next to the rete, in the lungs, and in the liver. In all these situations these bodies were mixed with other bodies, spindle-shaped, staff-shaped, and canoe-shaped. They appeared to be albuminoid in character.

Symptoms.—The incubation period of measles is ten or twelve days. The complaint then begins with the signs of catarrh. The patient is thought to have a cold : be sneezes, coughs, and his eyes look watery and red. With this there is fever ; often headache ; the appetite is poor; and the child generally feels ill and is languid. The catarrhal symptoms in crease ; the nose may bleed ; there is some soreness of throat ; and the patient is often hoarse, and complains of soreness in the chest. If the fever is high, the child may wander at night and be very restless. Some times the attack is ushered in by a convulsive fit, and occasionally the convulsions recur later on, either before the rash has appeared or after wards. The skin is generally moist, although the temperature rises to 102° or 103°, or even higher. In a case which came under my own notice at this stage, a boy was seized with diarrhcea on July 10th. His temperature on that evening was 102°. The next morning it was 103°, but the bowels acted five times in the course of the day, and in the evening it had fallen to 101.4°. His pulse at that time was 160, and his respirations were 48. On the evening of the 12th the temperature was 102°, and on the morning of the 13th, when the rash appeared, the mercury marked 103° ; pulse, 124 ; respirations, 48. Although pyrexia is the rule during the pre-eruptive stage, in exceptional cases the temperature may be normal. I have known this to be the case in two instances. In each of these young children the bodily heat, both morning and evening, for the four clays before the appear ance of the rash was between 98° and 99° ; and when the eruption began the temperature only rose to 101°. The rash was typical in character, and all the catarrhal symptoms were present.

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