§ 103. Measles, morbilli.

The measles are frequently epidemic in spring, and are generally a mild disease, though sometimes fatal. This disease occurs in every climate, attacks principally children, and breaks out ten days or a fortnight after the infection.

Diagnosis: spots which are generally more or less raised, one or two lines in diameter and at first resembling flea-bites; they gradually cluster in groups, having an irregular shape somewhat resembling a half moon. Several days previous to the appearance of the spots the patient is affected with catarrhal symptoms, such as short and dry cough, red eyes with lachryma-tion, frequent sneezing; the spots remain upon the skin for three or four days, after which they scale off. While the spots are out, the cough and the affection of the eyes continue. The desquamation of the epidermis is sometimes the only sign by which we are able to recognise the existence of the eruption.

We distinguish the following three stages in this disease:

* This kind of rash is apt to appear in persons suffering with nervous irritation. It may be excited by any of the above-mentioned causes, and requires the administration of Aconite as its most suitable specific. - Hempel.

1. The febrile stage, which lasts three days, and sometimes a little longer; the fever is remittent, and attended with the following catarrhal symptoms: sensitiveness and slight inflammation of the eyes, attended with puffiness of the eyelids, lachrymation, photophobia; frequent sneezing and discharge of water from the nose; troublesome, short and dry cough, with hoarseness and difficulty of breathing, frequently accompanied with moaning, roughness and slight soreness of the fauces; pain in the back or epigastrium; aching in the forehead, delirium, spasmodic symptoms, diarrhoea; white-coated tongue, with bright-red edges. During the period of dentition, and in children generally, all the symptoms are more violent than in full-grown persons, and the fever increases steadily until the eruption appears upon the skin.

2. Eruptive stage. The eruption appears at the end of the third or fourth day, generally on the face and arms first. The spots continue to appear for three or four days, and, if very numerous, are attended with swelling of the face and hands. The fever and uneasiness increase, the eyes are not very sensitive to the light, the cough frequently increases to bronchitis and pneumonia. The symptoms abate on the fourth day, when the eruption grows paler, and if the fever should still continue, there is either a complication, or else it is owing to a violent irritation of the skin in consequence of the extreme violence of the eruption.

3. The stage of desquamation. The scaling off commences on the sixth or seventh day, and sometimes even later. If the eruption be slight, the scaling is scarcely perceptible; in its stead we perceive a healthy sweat, critical urine and diarrhoea, terminating in the disappearance of all the remaining morbid phenomena.

In this stage the patients are sometimes exposed to real danger. The catarrh increases to pneumonia, which is followed by hectic fever, hydrothorax, haemoptysis, and, in scrofulous subjects, by real consumption. Measles are likewise followed by other kinds of cachexia, such as otorrhoea with pain and deafness, obstinate inflammation of the eyes and lids; swelling of lymphatic glands, or diseased condition of the mesen-teric glands leading to consumption. Chronic cutaneous eruptions are also consequent on measles, such as ecthyma, rupia, herpes and pustulous porrigo, with swelling of the lips, ulceration behind the ears, and chronic suppuration.

The prognosis is doubtful in little children, or in full-grown persons when the disease is complicated with pneumonia, or meningitis; also in pregnant females; or when the eruption is slow in coming out, or when the breaking out is interrupted, or when the spots look pale, or when the retrocession of the eruption is accompanied with nervous spasms, or, finally, when the spots are complicated with petechiae, haemorrhage and colliquative phenomena.

§ 104. In the first stage a very small dose of Pulsatilla frequently arrests the course of the disease. Pulsatilla is likewise recommended as a prophylactic, giving a small dose every two or three days. Others consider Aconite as the specific for measles.

Aconite should undoubtedly be given if the fever be very violent, with dulness of the head, heat in the head, vertigo, redness of the eyes, photophobia, -bloatedness of the face, languor and prostration. Aconite is to be continued as long as the symptoms have an inflammatory appearance. Aconite has proved a specific in several epidemics, where the organs of deglutition and bronchi were principally affected, when the stools were diarrhoeic, fermented, green, sometimes frothy and clayish, and when the measle spots were mixed with erythema. Euphrasia is frequently useful in this stage when the eye-balls are inflamed, with photophobia, profuse secretion of mucus from the eyelids, violent fluent coryza, aching pain in the forehead, violent cough in the day-time. When the patient is disposed to weep, and body and mind are very sensitive; when children are troubled with convulsive symptoms, grating of the teeth; when the patients are very wakeful and constantly tormented with a dry and short cough: Coffea is extremely suitable.* After Coffea are sometimes required Pulsatilla, Bryonia, Phosphorus, Sulphur.

If, previous to or during the eruptive stage, the patient should be tormented by violent thirst which they are unable to quench, on account of the stinging in the swollen throat during deglutition; if the patient should moreover be tormented with a dry, rather spasmodic cough; if the sclerotica should appear injected with lachrymation and a glassy appearance of the eyes; if the patients should be uneasy and should suffer with anxiety, nervousness and sleeplessness: Belladonna corresponds to that state better than Aconite. In very few cases Mercurius is indicated by the peculiar angina faucium.

Bryonia is an excellent remedy to counteract the hurtful effects of the retrocession of the eruption, or to bring it out again upon the skin. It is particularly indicated when the eyes are sensitive to the light, and. when the patient is constantly tormented by a moist cough, which occasions a raw and sore feeling in the chest. Arsenic is excellent under similar circumstances, particularly when Bryonia does not relieve the symptoms in a few hours.

Pulsatilla is preferable to Bryonia, if a violent diarrhoea and mucous vomiting should have set in the place of the eruption. Ipecacuanha may be administered if the vomiting should be very violent, in some cases Cina may be given. Dulcamara will be found more suitable if the diarrhoea should predominate. The bad effects arising from a retrocession of the sweat (in measles as well as in any other acute eruptive disease) are met by Nux v. or Cocculus. Chamomilla is sometimes indicated when the eruption is driven in, in consequence of a cold, when merely bluish spots remain upon the skin, accompanied with nausea, colic, watery stools, and difficulty of breathing.

In epidemic measles, the exanthem is frequently entirely wanting, and there are no other symptoms except a catarrhal inflammation of the eyes, headache, fever and delirium. These symptoms are controlled by Aconite and Belladonna; in some cases Hepar s., Sulphur or Calc. carb. are required besides.

* Aconite perhaps still more so. - Hempel.

If the eruption should be complicated with typhoid or putrid symptoms, the remedies indicated in §§ 75, 70, and 80, have to be employed.

Among the morbid conditions remaining after measles, we distinguish mucous diarrhoea, which is removed by Pulsatilla, Dulcamara, Mercurius, Chamomilla, Rheum, Sulphur, Rhus tox., Acidum phosph., China; a raw, dry cough, which yields to Chamomilla, Ignatia, Nux v., Ipec, Coffea, Hyosciamus, Drosero, Hepar s., Cina, and in some places Arnica;* a spasmodic cough, resembling hooping-cough, yields to Bellad., Cina, Hy-oscyamus, Conium, Ipec, Bryon., Cuprum, and other remedies.

Morbillin is recommended by some physicians as an excellent remedy for measles. I have used it with great benefit in some of the after diseases of measles.