The eruptive fevers are all divided into three stages, namely: a stage of invasion or development; a second stage when the eruption appears, and while it lasts; and a third stage, that of desquamation, when the eruption begins to fade or exfoliate in branny scales.
(j) Measles is generally a mild and not serious disease, and only attacks the individual but once in a lifetime; only through gross carelessness the disease becomes complicated, and then it may become a very dangerous affection. It begins with all the symptoms of a common cold. There is frequent sneezing, and an acrid muco-serous discharge from the nostrils. The eyes are irritable, reddened and watery, and there is more or less intolerance of light. The voice becomes hoarse and there is always a bronchitis present which is characterized by a dry, harsh cough. The patient is generally feverish, alternating with chilly sensations or shivering; the appetite is poor or absent and in some cases there is nausea and vomiting. The children feel drowsy; they complain of pain in the head and limbs and want to lounge around. The bowels may be constipated, but diarrhœa supervenes in a certain proportion of cases. In nervous children convulsions may occur; bleeding from the nose and false croup are not infrequently met with in the development of this disease. The duration of the first stage varies greatly in different individuals, and comprises a period extending from one to seven days. The eruption begins generally on the temples and forehead, whence it extends over the head and neck, thence down the back and over the entire body, occupying in its development from thirty-six to forty-eight hours. The eruption bears a resemblance to flea bites at first; it appears as minute red specks which gradually enlarge and become slightly elevated and arrange themselves in circular clusters. The portions of the skin that are free from the eruption retain their white appearance; the face is more or less swollen and the eyelids puffed. In some patients there is considerable annoyance from itching in the skin. The cough and bronchitis continue to be prominent symptoms, and the expectoration, consisting of yellowish sputa becomes abundant. In some children the fever runs very high in this stage and they become delirious and restless, but this is only temporary, for it generally diminishes with the eruption on the third or fourth day.
When the eruption begins to fade the third stage of the affection is inaugurated, and when there exist no complications, the patient may now be considered on the way to recovery which takes from four to eight days longer.
The treatment in measles should consist in good nursing, rather than in medication. Owing to the inflammation of the membranes of the eyes, the patient should be kept in a darkened chamber, and the eyes occasionally bathed with a solution of borax, by dissolving half a teaspoonful in a tumblerful of water. Good judgment forbids that the patient should be sweltered, but that he should be kept comfortably warm and never allowed to cool off suddenly is also very important. When the eruption is slow to develop a good sweat will often bring it out; so will undue exposure, to cold drafts and the transportation out of a warm bed into a cold one or drinking immoderately of cold drinks either delay the development of the eruption or drive it back, and from this undoubtedly dangerous complications arise, like pneumonia, diphtheritic croup, and convulsions. A mouthful of cold water now and then is harmless, but on the whole the drinks should be quite warm; the cough and bronchitis alone would require that.
Warm milk thoroughly beaten is the most suitable form of diet; broths and soups may be given for a change, so can a mixture of equal parts of weak hot tea and milk. The bowels should be moved with a mild laxative and if the fever runs very high, ten to fifteen drops of the sweet spirits of nitre, for a child five years old, in half wineglass of water every few hours will generally reduce the temperature. For the itching, the skin should be rubbed with equal parts of glycerine and warm water. The cough is generally the most troublesome feature, and the only symptom requiring regular medication; for this a good general cough mixture will serve every purpose, such as:
| Take: | Compound mixture of liquorice, | |
| Syrup of wild cherry, of each | 2 ounces |
Mix and give to a child four years old a teaspoonful every four hours; older or younger children in proportion.
(k) Rose rash, sometimes called false or German measles is a comparatively trivial affection and of very little importance, for it never has any serious complications and lasts only twenty-four or forty-eight hours in the majority of cases. It is often mistaken for measles, and one attack affords no protection against recurrences. The eruption appears in small rose-colored spots or patches which are not elevated. It does not commence on the head, but appears on different parts of the body. The eruption may be preceded by headache, loss of appetite, occasionally vomiting, and more or less fever or chilly sensations.
The affection of the eyes and air passages, especially the bronchitis which is characteristic of measles, are wanting in rose rash, and when we hear of children having had measles several times it is reasonable to presume that it was rose rash instead. This eruption hardly calls for treatment, but a mild laxative and a regulated diet would fulfill all requirements.
(l) Scarlet fever or scarlatina has received its name from the color of its eruption. This affection presents itself differently in different cases. It may be so mild in its attack that it constitutes a trifling ailment and again it may be so severe that life is seriously threatened, and destroyed in a few days. This has formed the basis of dividing scarlatina into three varieties, namely: simple scarlatina, diphtheritic scarlatina and malignant scarlatina.