MEASLES. 49 



The occurrence of diarrhoea, and sometimes of an ileo-colitis 

 with passage of blood and mucus, points to an affection of the 

 mucous membrane of the digestive tract. 



It appears probable that the virus is disseminated in the body 

 by means of the blood stream. This conjecture is strengthened 

 by the fact that the children of mothers suffering from measles 

 are sometimes born with the rash fully out. Moreover, the 

 eruption is itself produced by vascular congestion and small cell 

 infiltration. The congestion and infiltration are best marked in 

 the neighbourhood of the vascular papillae of the skin, and the 

 resulting infiltration of the subcutaneous connective tissue is a 

 very characteristic phenomenon of the disease. Subcutaneous 

 haemorrhages are not of very serious import in measles. There 

 is evidence that the supporting vascular stroma of the lung is 

 affected in a manner similar to the skin, giving rise to a special 

 form of interstitial pneumonic infiltration. 



Further evidence of the circulatory spread of the disease is 

 occasionally forthcoming in the form of various nervous affections. 

 Convulsions, delirium, coma, hemiplegia, myelitis, lateral column 

 symptoms, peripheral neuritis and transitory insanity have all 

 been known to occur. The myelitis has been found definitely 

 associated with vascular lesions. 



The lymphatic glands undergo a moderate enlargement in 

 measles, the submandibular, occipital, tracheo-bronchial, and 

 sometimes the axillary and inguinal groups being involved. The 

 glandular enlargement occurs early, and is usually slight and 

 transitory, but the bronchial glands in particular appear to be 

 rendered prone to tuberculous infection as a result. Often, 

 slight splenic enlargement accompanies the enlargement of the 

 glands. The enlargement of spleen and glands is probably the 

 consequence of blood infection. 



Those parts of the body which are liable to bacterial infection 

 from without are prone to suffer severely from secondary infec- 

 tions following measles. Thus the gangrenous process known as 

 noma occurs as a sequel, both in the cheek and on the vulva ; 

 secondary laryngeal and pulmonary affections constitute the 



C.A.A. 4 



