580 ACUTE INFECTIOUS DISEASES. 



complicated with the signs of dissolution of the blood. The fever 

 symptoms accompanying so-called inflammatory or synochal measles 

 resemble those observed in the course of acute inflammations. The 

 action of the heart is increased, the carotids pulsate strongly, the pulse 

 is strong, full, and more frequent, but not excessively so ; the bodily 

 temperature does not much exceed 104. Just as in the case of the 

 exanthema, the affection of the mucous membranes is characterized by 

 longer duration, greater intensity and extent, in synochal measles. 

 As long as the exanthema is at its height, the photophobia, nasal 

 catarrh, and cough remain the same. It is this form of measles also 

 which is chiefly accompanied by croupous instead of catarrhal laryn- 

 gitis, in which the inflammation of the air-passages often extends to 

 the alveoli of the lungs, in which also the gastric and intestinal mu- 

 cous membrane is often affected with catarrh (gastric measles). If a 

 hoarse, barking cough and the dyspnoea characteristic of croupous 

 laryngitis occur in the stage of efflorescence, the state of the patient 

 is by no means so free from danger as if these symptoms accompany 

 the prodromal stage ; but in such cases the disease readily takes a bad 

 turn, the dyspnoea increases, the breathing is impeded, and, as the 

 skin becomes congested, the exanthema subsides, or, if it has been ac- 

 companied by haemorrhage in the cutis, blue spots remain, which do 

 not disappear on pressure. In regard to the modification of the symp- 

 toms induced by an extension of the catarrh to the finer bronchial 

 tubes, we must refer to the first volume, where we have fully de- 

 scribed the symptoms of capillary bronchitis and the dangers accom- 

 panying it, particularly during childhood. The description of collapse 

 of the lung and catarrhal pneumonia in the first volume also gives the 

 symptoms from which we may determine that these complications ex- 

 ist. Indeed, it is to the numerous observations of collapse of the lung 

 and catarrhal pneumonia, afforded by extensive epidemics of measles, 

 that we owe our accurate knowledge of the pathological anatomy and 

 symptomatology of these diseases. Far more rarely than catarrhal 

 pneumonia we have croupous pneumonia during synochal measles ; it 

 is almost always limited to one side, while catarrhal pneumonia usually 

 affects both sides ; the fever accompanying the latter is ordinarily in- 

 sidious, and disappears gradually, while that with the former runs a cyc- 

 lical course and defervesces suddenly. The course of the fever due to 

 the measles is decidedly modified by the above complications. This 

 is especially true in the case of the pneumonia. While, in uncom- 

 plicated measles, the fever, which has reached its acme at the height 

 of the eruption, subsides steadily, and often rapidly, it may attain 

 its acme much later when there is a complication with catarrhal or 

 croupous pneumonia. If measles be accompanied bv severe disease of 



