57$ ACUTE INFECTIOUS DISEASES. 



the nose, and to extend upward to the mucous membrane of the frontal 

 sinus and conjunctiva, and downward to that of the larynx and trachea. 

 The stadium prodromorum usually lasts about three days, while the 

 above symptoms are of variable intensity ; but in some cases it lasts a 

 week or longer, and in others the symptoms are very slight, and 

 readily overlooked. Even in malignant epidemics, the fever preceding 

 the eruption is rarely severe enough to threaten life, as it is in scarlet 

 fever. Nor are the local symptoms, severe as they often are, and ter- 

 rifying as they seem to the friends (especially the croupy cough and 

 nocturnal dyspnoea), usually dangerous. True croup rarely occurs at 

 this time. Pfeilsticker's observations of the course of the fever during 

 the prodromal stage showed that the temperature was highest the 

 first day, and subsequently sank till the day of the eruption. Ziems- 

 sen and Hehn also mention cases where, after the bodily temperature 

 had attained a considerable height the first day, it became perfectly 

 normal the following days, and remained so till the eruption appeared, 

 when it rapidly increased. During the prodromal stage, Rehn ob- 

 served an eruption of pale-red, rather undefined spots on the mucous 

 membrane of the cheeks, gums, lips, and fauces ; and he explains the 

 increase of temperature at the commencement as being the eruptive 

 fever of this exanthema. 



The second stage of measles, the stadium eruptionis, commences 

 with an exacerbation of the fever ; the pulse becomes more frequent, 

 the bodily temperature rises to the highest point ; in some cases there 

 are convulsions. The above-described eruption appears first in the 

 face, especially about the mouth and eyes ; it soon spreads to the neck 

 and breast ; even in twenty-four hours it usually reaches the feet, so 

 that the whole body is covered. At this time the perspiration of the 

 patient has a peculiar odor, which strongly reminds me of a freshly- 

 picked goose. In rare cases, which generally show some other anom- 

 aly also, the eruption does not spread from the face to the extremi 

 ties, but makes its first appearance on the arms or legs, and afterward 

 elsewhere. Still more rarely, the exanthema is limited to certain 

 regions of the body, or, at least, on the rest of the body it is very in- 

 distinct. These cases resemble the morbilli sine exanthemate, which 

 unmistakably results from infection with measles poison, but from first 

 to last runs the course of a very severe catarrh, without the appear- 

 ance of any eruption. Lastly, cases occur where the eruption comes 

 out so slowly, that the stadium eruptionis is not completed in twenty- 

 four or thirty-six hours, but continues to the third or fourth day. In 

 these cases, the last spots frequently do not appear till the first ones 

 are fading away. During the eruptive stage, the constitutional dis 

 turbance and catarrhal symptoms usuallv increase, and attain theii 



