Page:Encyclopædia Britannica, Ninth Edition, v. 15.djvu/689

Rh M E A M E A 657 the junction of the Franklin branch with the main line of the New York, Pennsylvania, and Ohio Railroad, 102 miles from Salamanca. It is a well-built town, maintains a large trade with the oil regions, and has railway and other machine works, glass works, woollen mills, and paper mills. The Meadville theological school was established by the Unitarians in 1844; and Allegheny College, opened in 1816 as a Presbyterian Church institution, has been carried on since 1833 by the Methodist Episcopal Church. Meadville was founded by General David Mead as a fortified post in 1789. In 1816 it had only 400 inhabitants; but the num ber was 3702 in 1860, 7103 in 1870, and 8860 in 1880. MEASLES (Morbilli, Rubeola ; German, Masern ; French, Rougeole), an acute infectious disease occurring mostly in children. It appears to have been known from an early period in the history of medicine, mention being made of it in the writings of Rhazes and others of the Arabian physicians in the 10th century. For long, how ever, its specific nature was not recognized, and it was held to be a variety of small-pox. After the non-identity of these two diseases had been established, measles and scarlet fever continued to be confounded with each other ; and in the account given by Sydenham of epidemics of measles in London in 1670 and 1674 it is evident that even that accurate observer had not as yet clearly perceived their pathological distinction, although it would seem to have been made a century earlier by Ingrassias, a physician of Palermo. It is only within a comparatively recent period that measles has come to be universally regarded as a distinct and independent malady. Like the other eruptive fevers (exanthemata), to which class of diseases measles belongs, its progress is marked by several stages more or less sharply defined. After the reception of the contagion into the system a period of incubation or latency precedes the development of the disease, during which scarcely any disturbance of the health is perceptible. This period appears to vary in duration, but it may be stated as generally lasting for from ten to fourteen days, when it is followed by the invasion of the symptoms specially characteristic of measles. These consist in the somewhat sudden onset of acute catarrh of the mucous membranes. Sneezing, accompanied with a watery discharge, sometimes bleeding, from the nose, redness and watering of the eyes, cough of a short, frequent, and noisy character, with little or no expectora tion, hoarseness of the voice, and occasionally sickness and diarrhcea, are the chief local phenomena of this stage. But along with these there is well-marked febrile disturb ance, the temperature being elevated (102-104 F.), and the pulse rapid, while headache, thirst, and restlessness are usually present to a greater or less degree. In some instances, however, these initial symptoms are so slight that they almost escape notice, and the child is allowed to associate with others at a time when, as will be afterwards seen, the contagion of the disease is most active. In rare cases, especially in young children, convulsions usher in, or occur in the course of, this stage of invasion, which lasts as a rule for four or five days, the febrile symptoms, however, showing some tendency to undergo abatement after the second day. On the fourth or fifth day after the invasion, sometimes later, rarely earlier, the characteristic eruption appears on the skin, being first noticed on the brow, cheeks, chin, also behind the ears, and on the neck. It consists of small spots of a dusky red or crimson colour, slightly elevated above the surface, at first isolated, but tending to become grouped together into patches of irregular, occasionally crescentic, outline, with portions of skin free from the eruption intervening. The face acquires a swollen and bloated appearance, which, taken along with the catarrh of the nostrils and eyes, is almost characteristic, and renders the diagnosis at this stage a matter of no difficulty. The eruption spreads downwards over the body and limbs, which are soon thickly studded with the red spots or patches. Sometimes these become confluent over a considerable surface, giving rise to a larger area of uniform redness. The rash continues to come out for two or three days, and then begins to fade in the order in which it first showed itself, namely, from above downwards. By the end of about a week after its first appearance scarcely any trace of the eruption remains beyond a faint staining of the skin. Occasionally during convalescence slight peeling of the epidermis takes place, but much less frequently and distinctly than is the case in scarlet fever. At the com mencement of the eruptive stage the fever, catarrh, and other constitutional disturbance, which were present from the beginning, become aggravated, the temperature often rising to 105 or more, and there is headache, thirst, furred tongue, and soreness of the throat, upon which red patches similar to those on the surface of the body may be observed. These symptoms usually decline as soon as the rash has attained its maximum, and often there occurs a sudden and extensive fall of temperature, indicating that the crisis of the disease has been reached. In favourable cases convalescence proceeds rapidly, the patient feeling per fectly well even before the rash has faded from the skin. Measles may, however, occur in a very severe or malignant form, in which the symptoms throughout are of urgent character, the rash but feebly developed, and of dark purple hue, while there is great prostration of strength, accompanied with intense catarrh of the respiratory or gastro-intestinal mucous membrane. Such cases, always of serious import, are happily rare, occurring mostly in circumstances of bad hygiene, both as regards the individual and his surroundings. On the other hand, cases of measles are often met with of so mild a form throughout that the patient can scarcely be persuaded to submit to treatment. Measles as a disease derives its chief importance in the view of medical men from the risk, by no means slight, of^certain complications which are apt to arise during its course, mors especially inflammatory affections of the respiratory organs. These are most liable to occur in the colder seasons of the year and in very young and delicate children. It has been already stated that irritation of the respiratory passages is one of the symptoms characteristic of measles, but that this subsides with the decline of the eruption. Not unfrequently, however, these symptoms, instead of abating, become aggravated, and bronchitis of the capillary form (see BRONCHITIS), or pneumonia, generally of the diffuse or lobular variety (see PNEUMONIA), impart a gravity to the case which it did not originally possess. By far the greater proportion of the mortality in measles is due to its complications, of which those just mentioned are the most common, but which also include inflam matory affections of the larynx, with attacks resem bling croup, and also diarrhoea assuming a dysenteric character. Or there may remain as direct results of the disease chronic ophthalmia, or discharge from the ears, with deafness, and occasionally a form of gangrene affecting the tissues of the mouth or cheeks and other parts of the body, leading to disfigurement and even endangering life. Apart, however, from those immediate risks, it deserves to be borne in mind that in measles there appears to be a tendency in many cases for the disease to leave behind a weakened and vulnerable condition of the general health, which may render children, previously robust, delicate and liable to chest complaints, and is in not a few instances the precursor of some of those tubercular affections to which the period of childhood and youth is liable. These various effects or sequela? of measles plainly indicate that although in itself a comparatively mild XV. 83