ACUTE INFECTIOUS DISEASES. 



necting link with the sequelae of measles; for it often remains for 

 weeks or months after tne desquamation is over, and grows worse 

 from the most trifling causes. In many cases this cough appears to 

 depend on simple bronchial catarrh, and its obstinacy and occasional 

 exacerbations seem due to increased vulnerability of the bronchial 

 mucous membrane, or to a sensitiveness of the skin remaining after 

 measles ; but, hi other cases, the cough is more serious, and depends 

 on severe disease of the lungs. It is well proved that measles often 

 induces pulmonary consumption, and, consequently, that after an ex- 

 tensive epidemic of measles, the rate of mortality among children is 

 usually increased for a few years. But it appears to me very doubtful 

 whether the chronic pulmonary tuberculosis, often induced by measles, 

 is always or chiefly due to a deposit of tubercles in the lungs during 

 measles, or to softening of tubercles already existing there. Most 

 cases of phthisis pulmonum in children are not due to deposit and 

 softening of miliary tubercles, but to caseous transformation and disin 

 tegration of the products of lobular pneumonia, which is generally also 

 accompanied by caseous degeneration of the bronchial glands. But 

 as lobular pneumonia is one of the most common complications of 

 measles, it appears very probable that the frequent occurrence of pul- 

 monary consumption, as a sequel of measles, is due to further meta- 

 morphosis of the products of inflammation, which have not yet been 

 resolved. But this does not mean that true tuberculosis of the lungs 

 never occurs as a sequel of measles (for I have several times seen acute 

 miliary tuberculosis directly follow measles), but only that most cases 

 of pulmonary consumption after measles depend on chronic destructive 

 pneumonia. Besides chronic bronchial catarrh and chronic pulmonary 

 consumption, the whole series of scrofulous diseases, especially ophthal- 

 mia, otorrhcea, chronic rhinitis, swelling of the lymphatic glands, chronic 

 inflammation of the periosteum and joints, may be mentioned as se- 

 quelae of measles. At least, we very frequently see children, who 

 had never before suffered from scrofula, troubled for years with various 

 forms of these chronic inflammations after recovering from an attack of 

 measles. Among the sequelae of measles, which, fortunately, are rare, 

 we may mention the mortification of the cheeks or vulva, noma, and 

 the diphtheritis of the oral mucous membrane, stomacace, which occur 

 even during desquamation. 



TREATMENT. The only efficient prophylaxis is a strict isolation 

 of healthy persons, who have not yet had the measles, from those in 

 whom the disease has broken out, as well as from those that are sus- 

 pected of being in the prodromal stage. To protect children from the 

 affection, it is necessary to keep them out of school ; and it is still 

 better, if possible, to send them away from the place where an eoi 



