MEASLES 



of measles virus and antigens, of histamine and other 

 pharmacologically active agents. This liberation of antigen 

 will provoke a sharp secondary response of antibody produc- 

 tion as well as of lymphoid cell proliferation. In the normal 

 child one can assume that most of the measles cells suffer 

 necrosis and disintegrate. Cell debris and virus, both prob- 

 ably 'opsonized' with antibody globulin, presumably enter 

 the metabolic pool through phagocytosis and are rapidly 

 disposed of. In the agammaglobulinaemic child we picture 

 the same process minus any part played by circulating 

 antibody-globulin. Immunity following infection will be 

 ascribed to the continuing existence of immunologically 

 modified clones which will provide cells capable of damaging 

 measles cells and cutting short the process of virus multi- 

 plication in lymphoid tissue at an early stage. 



Giant-cell pneumonia is not exclusively a sequel of measles 

 but with the exception of pertussis the other aetiological 

 agents are not clearly established. Three cases in children 

 have been described from whom measles virus was isolated 

 from the tissues post-mortem (Enders, 1956; Cheatham, 

 1958) . It is of interest that, of these, one suffered from fibro- 

 cystic disease of the pancreas, one was in the terminal stages 

 of acute leukaemia and the third had been ' sick all his life ' 

 with recurrent diarrhoea. The condition may also be seen in 

 very young infants and occasionally in children without inter- 

 current illness. 



In most cases the measles rash is poorly developed, suggest- 

 ing some inadequacy of the immunological process. The 

 histology of the lung suggests strongly that many ' measles 

 cells ' have lodged there and have themselves developed into 

 giant cells as well as infecting adjacent alveolar and bronchio- 

 lar epithelium without effective hindrance by immunological 

 processes. The association with intercurrent debilitating 

 disease would suggest that the immunological deficiency is a 

 general one not to be allocated, for example, to an inability 

 to produce the patterns required. It has been noted by 



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