If the disease attacks one of feeble constitution whose environment is unfavorable and insanitary,—dwelling in badly ventilated rooms, for instance, with little attention paid to personal cleanliness, the attack is likely to assume a malignant form.
A period of from ten to fourteen days may elapse between infection and the development of the symptoms.
During this period the patient may infect others.
This explains how easily a whole school may become infected.
During the preliminary period children feel tired, relaxed, suffer pain in the joints and headache; they have chills and are feverish at evening. Among the symptoms enumerated are catarrhal affections of the air passages, the larynx, the nose and eyes. Constant sneezing, nosebleeding, cough, watering eyes, ultra sensitiveness to strong light, are concurrent conditions. At the same time the fever becomes pronounced.
These symptoms continue for four or five days and then rapidly abate and the eruption appears. First a red rash is seen, which spreads over the surface of the face. Inside the mouth and throat a similar mottled redness is seen. In the course of a day the eruption spreads over the whole body. After continuing at their height for a day or two the symptoms gradually decline, and in a little over a week the child may be pronounced well. The skin then sheds all the superfluous cuticle left by the eruption, and in three or four weeks after inception the normal condition is again reached.
In the malignant form all the symptoms are of a severe type. Occasionally catarrhal affections of the air passages, croup or pulmonary inflammation supervene, and the patient succumbs.
Other concurrent forms of disease are whooping cough, diphtheria, pulmonary consumption, inflammation of the eyes, ear disease, and swelling of the glands.
Measles demand no distinctive treatment. The room must be well ventilated, with a temperature of about 60°, and light must be almost totally excluded. At night no lamp should be allowed.
Treatment and diet should be the same as in scarlet fever.