MEASLES. 577 



have existed for any time, a very slight escape of blood into the cutis 

 appears to complicate the hypersemia, because these spots only lose 

 their color slowly and incompletely under the pressure of the finger, 

 and, after disappearing, they generally leave, for a time, a dirty-brown 

 stain. In some cases the spots acquire a dark, blood-red color, from 

 greater extravasation of blood in the cutis, and in these cases we also 

 occasionally notice petechiae between the spots (morbilli petechiales, 

 rubeolce nigrce). 



Since a large number of the deaths occurring during measles result 

 from complications with croupous laryngitis, bronchitis, or pneumonia, 

 we often find anatomical changes due to these diseases. Where death 

 is caused by laryngitis, it is by the croupous form. But in this second- 

 ary croup we do not find coherent pseudomembranes so often ,as we do 

 in common idiopathic croup. On the contrary, the exudation usually 

 infiltrates the upper layer of the mucous membrane, so that the inflam- 

 mation approaches the diphtheritic form of inflammation of the mucous 

 membrane. The lesion most frequently found in the bodies of children 

 who have died of measles, is capillary bronchitis, which has sometimes 

 induced permanent inspiratory distention of the alveoli (called acute 

 vesicular emphysema, by most authors; see Vol. I., p. 71), sometimes 

 collapse of the lung, and catarrhal pneumonia (Vol. I., p. 194). The 

 blood shows no characteristic change, but, as in other infectious dis- 

 eases, is poor in fibrin, fluid, and dark-colored. 



SYMPTOMS AND COURSE. During the period of incubation, there 

 is no sign of the disease. This is followed by the first stage, stadium 

 prodromorum, which rarely begins with a single chill ; more fre- 

 quently with repeated rigors, and is accompanied by all the symptoms 

 of a severe catarrh of the conjunctiva and air-passages, and the actual 

 disease can only be rightly interpreted from the existing epidemic. 

 Unless it be known that there is measles in the neighborhood, the 

 most experienced physician can hardly recognize in the existing severe 

 catarrh the prodromal stage of measles. Increased frequence of pulse, 

 heightened temperature, constitutional disturbance, pain in the head 

 and limbs, dyspepsia, nausea, vomiting, disturbed sleep, and, in exci- 

 table children, delirium, occur also during simple catarrh, from catching 

 cold. The local symptoms are generally very decided ; the burning, 

 reddened eyes shun the light, and are filled with tears, there is pain 

 in the forehead, the nose is stopped, and discharges a copious, limpid, 

 salty secretion ; attacks of sneezing occur at short intervals, and often 

 continue for hours; there is, sometimes, epistaxis, the voice is husky, 

 the painful cough is hoarse and barking ; at night, the attendants are 

 often frightened by the symptoms of pseudo-croup, previously described 

 (Vol. I., p. 6). The catarrhal affection appears generally to begin iu 



