Measles.

The disease, also known as morbilli and rubeolay is of far less
importance, with regard to the immediate danger to life, than either
small­pox or scarlet fever ; and yet there so often follow in the train
of measles complications which may have a permanent effect upon
the health and vigor of the individual, that the disease is, neverthe­
less, one of considerable importance. Moreover, it is important to
be able to recognize measles because of the similarity of this disease
with scarlet fever, and the consequent possibility of mistaking one
for the other.

The period of incubation—the interval between exposure and
the onset of the symptoms—is from ten to fifteen days; then occurs
the stage of invasion. The onset of the disease resembles agsevere
cold or an attack of influenza. The individual sneezes repeatedly,
and there is an acrid discharge from the nostrils ; the eyes are also
usually inflamed, red and watery. There is, also, soreness of the
throat, hoarseness, and a dry, painful cough. At the same time
there is usually a chilly sensation, perhaps shivering, but rarely a
distinct and pronounced chill. Then begins a fever, usually less
intense than that of scarlet fever ; the appetite is impaired; nausea
and vomiting may occur ; there are wandering pains in various
parts of the body, especially in the head and limbs ; there is gen­
eral debility and languor. In children more marked symptoms,
such as convulsions and bleeding at the nose, may occur ; some­
times, too, the disease is ushered in with an attack of false croup.
 
After a time, which varies somewhat, though averaging about four
days from the beginning of the symptoms, there occurs the stage of
eruption. The rash is usually first seen on the forehead and tem­
ples, rapidly spreading over the face and neck. Within forty-eight
hours the entire body and extremities are covered. It will be
noticed, therefore, that the spread of the rash in measles is less
rapid than in scarlet fever or small­pox.

The rash begins with minute red specks similar to those of the
scarlatinal rash, except that the color is a less intense red; the rash
of measles, moreover, is usually arranged in somewhat crescentic
patches. The specks at this stage resemble the pimples of small­
pox before the formation of vesicles, but they do not give that
shot-like sensation to the finger; they are more like flea bites.
The eruption is often attended, like that of scarlet fever, with con­
siderable itching, and there may be some swelling of the skin,
especially on the face. Sometimes a few vesicles may be observed
among the dark red patches. The fever continues until about the
fourth day after the appearance of the rash, when both fever and
eruption gradually disappear. The rash begins to fade where it
began to appear—on the face.

Most of the symptoms which were present before the appear­
ance of the rash—the inflammation and discharge from the eyes,
nose and throat—continue during the eruption.

Stage of Desquamation.—The fading of the eruption and
the scaling of the skin occupy ordinarily four to eight days. The
skin does not peel off to the same extent as in scarlet fever, the
scales being always small and not patches. The fever which has
persisted during the eruption now begins to decline, though the
cough and inflammation in the eyes may continue for some days
subsequently.

Such is the history of an ordinary case of measles; there are
several variations from this type, and several complications may
aggravate the gravity of the disease. The affections of the eyes,
nose and bronchial tubes, though quite characteristic of this disease,
are sometimes wanting; and there are cases which are unmistakably
measles, though the peculiar rash is but imperfectly developed.
Sometimes, too, severe cases of measles, like those of scarlet fever,
are characterized by the escape of blood from the blood-vessels into
the skin, making diffuse dark-red patches. 

Among the complications which often follow measles are ob­
stinate affections of the eye and of the larynx, and severe inflam­
mation of the lungs; somewhat less frequently there occur attacks
of diphtheria and true croup. A possible complication also is deaf­
ness, originating in the same way as was described in connection
with scarlet fever.

The more important points distinguishing this disease from
scarlet fever and small­pox are the length of the period of incuba­
tion, the long interval after the first symptoms before the rash ap­
pears, the affection of the eyes, nose and air passages, the appear­
ance of the eruption first on the face and its gradual extension
over the body, the dark-red color of the rash and its arrangement
in circular or crescent-shaped patches. Until the appearance of the
rash it is impossible to decide definitely upon the nature of the
complaint, and hence in those exceptional cases in which the rash
does not appear a definite diagnosis is almost impossible.

Treatment.—The directions already given for the treatment
of mild cases of scarlet fever apply equally well to measles, except
that in the latter complaint there is rarely any necessity for local
treatment of the throat. Sometimes it becomes necessary to make
cold applications to the eyes, or to administer a few drops of pare­
goric for the cough. The usual indications for treatment consist
in the complications already described. Only one requires especial
notice here—the tendency to consumption, which seems to be con­
ferred in some cases of this disease. This should be borne in mind
in the after-treatment of measles.

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