Convulsions have been already mentioned as occasionally marking the beginning of the disease. The fits may be repeated several times ; but when limited to the first day or two of the disorder, although alarming to the friends, are seldem dangerous. Should they be repeated, however, during the eruptive stage, they must be regarded with more anxiety, for they may then prove fatal.
Epistaxis, a common symptom and generally insignificant, may become profuse and exhausting. In severe epidemics, where the type of the dis ease is a low one, this may be of serious moment. In any case it must tend appreciably to protract the period of convalescence.
Diarrhona is also, as a rule, a symptom of little consequence ; but some times the mild intestinal catarrh to which it is owing may be converted into a real colitis. The stools are then bloody and glairy, and there is colic with great tenesmus and pain in defecation.
Laryngitis is a marked symptom in some epidemics. There is gener ally a certain amount of hoarseness early in the disease from participation of the laryngeal mucous membrane in the general catarrh. If this get worse the voice becomes husky and almost extinct, the cough hoarse and " croupy," and the breathing noisy and oppressed. Great alarm is natu rally excited by this condition of the patient, but the danger is really slight. When the rash begins to fade, an improvement is noticed in the throat symptoms ; and they often disappear quite suddenly when the tem perature falls. It must not be forgotten that laryngitis with marked spasm may arise quite at the beginnino. of the attack, and be out of all proportion to the signs of general catarrh. In such cases the existence of measles may not be even suspected until the eruption comes out and discloses the nature of the disorder.
Ophthalmia and otitis are less common symptoms. When these occur, it is usually in children of marked scrofulous tendencies. The first may form an obstinate complication, and the second may lead to very serious consequences. (See Otitis.) Extension of the bronchial catarrh to the smaller tubes is a very grave accident. It is common in babies and young children, and almost invari ably proves fatal, for in early life collapse of the lung is easily provoked, and once established quickly terminates the illness. The first indication of danger in these cases is oppression of the breathing, which becomes very rapid. There is lividity of the face, and the countenance is haggard and distressed. With the stethoscope we hear abundant fine subcrepitant rhonchus over both sides of the chest. When these symptoms are present, very active measures must be taken to avert a fatal issue to the com plaint.
In children who have passed the age of twelve months catarrhal pneu monia is a more frequent complication than the preceding. If, in any case, on the fading of the rash the temperature undergoes little climiuu tion, we may expect catarrhal inflammation of the lungs to be present. In such a case the child, instead of becoming better and more lively as the eruption disappears, seems to be weaker and less well than before. His face, the swelling having subsided, is seen to be pinched and haggard looking ; there is lividity about the lips ; the flares act in inspiration, and the breathing is quick and labored. A thermometer in the axilla marks about 102°, seldom higher. The patient is thirsty, but will take little food. He shows no interest in his toys, but often lies picking at his lips and fin gers, indifferent to everything but his own uncomfortable sensations. Ex amination of the chest reveals all the signs of acute catarrhal pneumonia.
This complication may also come on at an earlier stage, when the erup tion is beginning to appear. The development of the rash is then retarded. or the exanthem may even retrocede with great aggravation of the general symptoms. Catarrhal pneumonia is fully described in another part of the volume, but it may be mentioned in this place that catarrhal inflammation complicating measles often runs a subacute course, and persists long after all signs of the primary complaint have disappeared. It may end in death, in complete recovery, or may become a chronic lesion forming one of the varieties of pulmonary phthisis.
Sequelce.—The sequels of measles are constituted in part by the above mentioned complications, which, like catarrhal pneumonia, may become chronic and give rise to trouble and anxiety. Chronic laryngitis ' and bronchitis are common sequences. Enlarged bronchial glands often re main for a considerable time relics of the disease which has passed away. Also, it may again be repeated that in children of scrofulous tendencies an attack of measles may light up the cachexia, and give rise to any or all of the troubles which are characteristic of that constitutional state. Even children who are free from this unfortunate predisposition may not escape unhurt from the attack. A condition of the system is often left which ap pears to favour the occurrence of secondary disease ; and whooping-cough, croup, gangrene of the mouth and vulva may occur at such a short interval after the attack that they cannot but be looked upon as direct sequelw of the illness.