122 EEVIEW — TROPICAL MEDICINE, ETC. 



Measles. Khartoum has once suffered from an epidemic of measles, and that the 

 disease is one of great importance in tropical countries is evident from the report'* of the 

 Sanitary Commissioner for the United Provinces of India in 1903, wherein it is stated that 

 in 23 districts, measles was returned as one of the chief causes of infantile mortality. In 

 all it accounted for no less than 98,112 deaths, being present in true epidemic form. 



The point which chiefly concerns us is the nature of the more modern methods taken 

 for its prevention, but in the first place attention may be drawn to the work of Hektoen-* 

 on experimental measles, which led him to conclude that the virus of measles is present in 

 the blood of patients with typical measles some time at least during the first 30 hours of the 

 eruption ; furthermore, that the virus retains its virulence for at least 24 hours, when such 

 blood is inoculated into ascites broth and kept at 37'' G. At the same time, the exact 

 nature of the virus has not been determined, and Hektoen's work is open to criticism as no 

 mention is made of Koplik's spots occurring in the persons inoculated with blood from 

 measles patients, although they seem to have developed typical catarrhal symptoms. 



Eosenberger^* blistered the skin during the eruptive stage in measles, and in the fresh 

 serum thus obtained found in 39 out of 41 cases. 



A more or less constant hyaline body, possessing the following characteristics. In size it varied from 1/10 to 

 1/6 of the diameter of a red blood-cell. It was generally spheroid, but ovoid or pyriform forms 

 were also seen. It was, as stated before, perfectly hyaline, and possessed, or had attached to it, a round or 

 irregular oval-shaped granule of a brownish-black colour, which was actively motile. This granule travelled 

 round the entire periphery of the body in a most deliberate manner, stopi^ing every now and then, and appearing 

 to try to gain an entrance into the body. In two or three instances flagella were seen, but never more than two. 

 In the same specimen of fluid another hyaline body, also motile, but containing two to four small motile 

 granules, was occasionally seen. Attempts to cultivate the body were made, but without success. Serum from 

 normal persons, a few cases of scarlet fever, and a number of syphilitics, did not contain this body. 



Koplik's spots have been mentioned. Their value in diagnosis has been shown by 

 Bruening,^* who found them present in 60 cases of measles out of 52 examined. They were 

 found from six days to one day before the appearance of the rash, and were not present in 

 many cases of German measles, scarlet fever and serum eruptions. 



The best account one has seen of Koplik's spots occurs in a review of Bing's' work, 

 " Les Taches de Knplik, leur Importance pour le diagnostic et la Prophylaxie de la Bougeole." 



We quote it in full : — 

 In its typical and characteristic form, Koplik's sign consists of a macule and a papule ; the macule is a 

 rose spot of irregular, star-like, or rounded outline ; the whitish-blue papule forms the central point of it and is 

 alone the characteristic and pathognomonic constituent of the spot. It is usually only just large enough to be 

 visible and never exceeds a diameter of one millimetre, consequently the statements often made that this central 

 spot is from two to five or more millimetres in diameter, show that other buccal eruptions are frequently mistaken 

 for it. This papule projects slightly and can be felt with the finger ; it is associated with a slightly rough or 

 lustreless appearance f" aspect d^poii ") of the mucous membrane, which is often of great value, since it appears 

 quite early and persists after the actual spots have disappeared. The number of spots varies within very wide 

 limits, being in some cases only one and in others several hundreds. After a time the rose spots tend to run 

 together and coalesce, but the white centres maintain their individuality. They are found only upon the mucous 

 membrane of the lips and cheeks, and not, as some few authors have described, upon the gums, the soft palate and 

 the tongue. Dr. Bing maintains that such spots are the erythemato-pultaceous stomatitis described by Comby, and 

 not Koplik's spots ; moreover, small punctiform vesicles occur upon the palate in a variety of conditions, including 

 rubeola, scarlet fever and influenza, as described by Koplik himself. The buccal eruption appears to go through a 

 definite cycle which may take from two to six days to accomplish, but the disappearance is more or less abrupt 

 since the small white spots become easily detachable and are removed by the buccal secretions, while ulceration 

 never occurs. The diagnosis and the nature of the sign are carefully described and exhaustively discussed by 

 Dr. Bing, who then details his own observations. He concludes that the sign is pathognomonic of measles, but 

 that its absence docs not prove that the patient does not suffer from that disease. With regard to the time of its 

 appearance, he finds that it may appear from one to five days before the erujition, but most often two days before ; 

 it reaches its maximum on the day on which the rash first appears on the face, commences to disappear on the full 

 efflorescence of the rash, and does so completely from the second to the fifth day of the eruptive stage. He 

 further considers the value of the sign in diagnosis and, after an exhaustive study of the conditions likely to be 

 mistaken for measles, arrives at the conclusions that it is a sign of the utmost value, and that in every case of 

 illness in a child it should be sought, since it enables isolation to be carried out sooner tlian would be possible 

 otherwise. The character of the spots has no bearing upon prognosis or on the severity of the attack. 



As regards prevention, a recent and excellent article will be found in M'Vail's'' work. 

 He points out that the infection, which is very evanescent, is transmitted by the air and 



' Quoted in Indian JIalical Gazette, I. 1905. Vol. XL. 



•' Hektoen, L. (March, 1905), " Experimental Measles." Journal of Infectious Diseases, Vol. II. 



' Rosenberger, R. C. (June, 1906), "American Medicine." Quoted in Medical Annual for 1907. 



" Bruening, H. (1906). Deut. Med. Woch., Bd. XXXI., No. 10. 



» Lancet (May 18th, 1907). Vol. I. 



« M'Vail, J. C. (1907), "The Prevention of Infectious Diseases." 



* Article not consulted in the original. 



