A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck.
- Adolph Strümpell
- Date:
- 1901
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![respiratory passages (vide infra). The disease can be artificially produced by in- oculation of healthy children with the blood or liquid secretions of those suffer- ing from it. Clinical History.—The length of the stage of incubation is tolerably uniform. It is ten days to the beginning of the first symptoms, and thirteen or fourteen days to the breaking out of the eruption. These figures have been established by the observations of Panum, the opportunity having been afforded upon the first introduction of the disease into the Faroe Islands. As a rule, there are no espe- cial prodromata during the period of incubation except some slight elevations of temperature. At the end of ten days the initial stage * begins, generally sudden- ly, and with an abrupt rise of temperature to 102° or 104° (39°-40° C). At the same time the characteristic catarrhal symptoms appear: nasal catarrh (coryza), to be recognized by the abundant nasal secretion, the frequent sneezing, and sometimes also by nose-bleed; more or less severe conjunctivitis, characterized by photophobia, reddening of the eyes, and increased flow of tears; and, lastly, symptoms of a catarrh of the upper part of the respiratory tract, usually mod- erate, but nevertheless causing hoarseness and a slight cough. With all this the general condition is disturbed, the children are restless, have headache, and eat little. Symptoms of a mild sore throat are not infrequent, but are very far from being so prominent as in scarlet fever. These initial symptoms last, as we have said, three or four days. Then the eruption begins (stage of eruption). This is very often preceded for a day or two by a peculiar, usually spotted, reddening of the hard and soft palates, termed eruption upon the mucous membrane. [Koplik, in 1898, called attention to an eruption of bluish-white specks, surrounded by a reddish area, upon the mu- cous membrane of the cheek and lips, occurring twenty-four to seventy-two hours before the cutaneous exanthem. Others confirm his observations and regard Koplik's spots as a great aid in early diagnosis.—V.] The true eruption of measles begins almost always in the face, on the cheeks, forehead, and around the mouth (contrasting with the characteristic pallor of the chin in scarlet fever), and spreads from there rapidly downward over all the rest of the body. The erup- tion consists at first of little papillae, corresponding to the follicles. These are soon surrounded by a pale-red, slightly elevated border, and in many cases become confluent. Perfectly flat elevations, of various sizes and of extremely irregular, dentated, roundish, or angular shape, develop. They are often so thickly crowded together as to touch one another, but usually limited portions of normal skin intervene between them. Within each raised spot the little follicular papillae remain visible. With the beginning of the eruption the fever rises, having been, as a rule, slight during the last days of the initial stage. It attains about 104° or 105° (40°-40.5° C). In thirty-six to forty-eight hours the eruption reaches its full development and its greatest extent. The fever and the catarrhal symptoms also persist for the same length of time. Sometimes we find a slight swelling of all the lymph-glands. Then follows a decline in the fever, usually rapid, and indeed almost by crisis, while the eruption after a short period of full development begins gradually to fade during the two or three days following. At the same time the catarrhal symptoms diminish. A more or less extensive desquamation of the epidermis begins, scarcely ever in large pieces as in scarlet fever, but in little scales, like bran. In eight or ten days, if the disease runs a normal course, the patient is fully convalescent. * We consider the term initial stage more correct than prodromal stage. The larodromal symptoms are the first slight symptoms which occur during the time of incubation of an infectious disease, while the symptoms presented by measles before the breaking out of the eruption are a part of the already developed disease. 4](https://iiif.wellcomecollection.org/image/b21206296_0077.jp2/full/800%2C/0/default.jpg)
