MEASLES. 581 



the respiratory organs, and the consequent difficulty of breathing or 

 fever induce collapse, the eruption becomes pale, and may entirely 

 disappear in a short time. This symptom is often falsely interpreted, 

 as the disappearance of the eruption is regarded as the cause, not the 

 result, of the distress and of the bad symptoms in the respiratory ap 

 paratus. 



A third class of measles described is the asthenic, typhous, or sep- 

 tic. In this very malignant form of the disease, the danger lies, not in 

 the extension of the catarrh to the bronchi, or in severe complications, 

 but in the pernicious influence of the measles poison on the entire or- 

 ganism. Measles resembles most acute infectious diseases in regard to 

 the great difference in the constitutional disturbance induced by the 

 infection during different epidemics. A physician who has only ob- 

 served epidemics of erethitic or synochal measles, such as have exclu- 

 sively occurred in Germany during the past ten years, may readily 

 suppose that measles poison has little constitutional effect. But this 

 view will soon be altered the first time he sees a case of asthenic sep- 

 tic measles. Even in the prodromal stage, the pulse, which is at first 

 full and strong, may become small, weak, and very frequent ; the pa- 

 tient very much depressed, the intellect cloudy, the tongue dry and 

 crusted, and patients may die of the increasing prostration, which is 

 occasionally interrupted by eclamptic spasms, even before the appear- 

 ance of the eruption. In other cases, these typhoid symptoms, which 

 are often accompanied by abundant epistaxis, do not begin, or do not 

 become dangerous, till the outbreak of the eruption. The exanthema, 

 which is usually irregular, is sometimes pale red ; sometimes bluish- 

 violet, as a result of coincident haemorrhage into the skin ; occasionally 

 there are petechiae between the spots, or bluish spots remain after the 

 exanthema has quickly disappeared. When the pulse has become 

 very small, and cannot be counted the extremities cool, while the 

 body is hot most patients die in a soporose state, with or without 

 general convulsions. It has not yet been accurately ascertained 

 whether the adynamia and paralysis occurring during measles, in- 

 ducing the so-called asthenic, typhous, or septic form of the disease, 

 be a direct result of the blood-poisoning, or if they be due to the ex- 

 cessive increase of bodily temperature induced by the infection. The 

 latter view is apparently supported by the fact, that in diseases not in- 

 duced by infection, as soon as the bodily temperature rises above a 

 certain point, the pulse becomes small and weak, and the same ner- 

 vous or typhoid symptoms appear ; as well as the second fact, that 

 remedies which lower the bodily temperature have a decidedly favor- 

 able effect on these symptoms. 



The cough continuing during the desquamative stage forms a con- 



