in a case of black measles, the epidermis became detached from the skin on the least pressure and could be raised with great facility. снижайте In some children the measles comes out imperfectly, it appears on properly one part of the body or is tardy in appearing, and sometimes, after having manifested itself, it immediately disappears. This is what has allell, been termed anomalous measles, properly so called. This variety is very unfavourable, for it is often accompanied by convulsive nervous symptoms or with functional derangements on the part of the stomach. Finally, the last variety of measles of which we have to speak, is the measles without eruption, febris morbillosa, the existence of which has been very wrongly denied by many physicians. It is especially endles observed in the time of an epidemic. Certain children have fever, coryza, lachrymation, bronchial catarrh, but they have no eruption at житанев all (Gregory, Guersant). Usually in a similar case, there is no well characterized eruption of measles; but several patches appear on the neck and on the shoulders which have the appearance of patches of measles. It is to this disease that the term of febris morbillosa given by Sydenham is to be applied. ON THE IMMEDIATE OR DISTANT INFLUENCE OF MEASLES ON THE HEALTH. Measles is rather frequently the cause of very serious morbid symp-` Eruption toms. Lobular pneumonia, termed, by reason of the circumstances?! which preside over its development, morbillous pneumonia, is, as is finem. known, very fatal. Diarrhoea is a less frequent symptom, but not less dangerous, for entero-colitis is often the consequence of it. Convulsions nouid in measles are very often fatal. The eruption of measles is sometimes the source of cutaneous iacri's affections of the ears, eyelids, or skin in general. It is often accom panied by vesicles similar to those of miliaria, by the bullæ of pemphigus, t and especially by impetigo in scrofulous children. This last mentioned affection is that which is developed on the eyelids and behind the ears. It should be treated by slight purgatives and by astringent applications so as not to allow it to establish itself in a decisive manner. If measles is the occasion of the development of some cutaneous affections, it is thus in return, in many cases, the cause of their disappearance. Thus it is related that several children labouring under Cr chronic diseases of the skin have been cured of them by this disease. One does not always agree on the nature of the influence exercised SELL by the affection of measles in this case. Is it salutary, or is it noxious? a question which it is impossible to decide. M. Rayer believes that this influence is salutary, and he founds his belief on the fact of a young girl whom he attended and whom he saw cured of a chronic eczema of the scalp, face, and ears, in consequence of the disease we are now discussing. On the other hand we might look upon this influence as a very fatal one if we formed our opinion of it from the two cases reported by Alibert, and in which death rapidly came on in two children cured of impetigo of the scalp by an attack of measles. As is seen, the question is not sufficiently elucidated by experience, and it is necessary to wait for fresh facts before we can form an opinion on this point. The thoracic symptoms which are developed so frequently as the consequence of measles give evidence of its distant influence on the constitution of children. In fact, how many times has not one observed after this disease, pulmonary tubercles become developed in subjects who did not appear to be predisposed to them! How many times, also, has not one seen under this influence the tubercular affection, latent in children, assume a fresh impetus and progress with an unexpected rapidity? For, in fact, measles exercises a true influence over the development of pulmonary tubercles, and very much accelerates the progress of this disease in the children who are attacked by it. APHORISMS. 306. Fever accompanied by redness of the eyes, lachrymation, and sternutation, is a precursory symptom of measles. 307. Measles commencing by a convulsion is always unfavourable. 308. Measles without catarrh always terminates favourably. 309. Measles accompanied by catarrh is often complicated with pneumonia. 310. The pneumonia of measles, which is described under the term of morbillous pneumonia, possesses a specific nature, which modifies its appearance and which renders it very fatal. 311. The pneumonia of measles is most frequently fatal. 312. The pneumonia of measles engenders, more than any other variety, the miliary granulations of phthisis. 313. Anomalous measles are always serious by reason of their sudden and unexpected complications. BOOK XVI. ON INTERMITTENT FEVER. Intermittent fever is a general disease, characterized by intermittent febrile attacks, the cause of which is to be traced to miasmatous impoisonment. The history of the intermittent fever of children at the breast has been neglected by all the physicians who have written on the diseases of infancy. This is to be regretted, for there are few diseases of the first stage of infancy which present so great an interest. I am the first who has given the description of it, and since then I have with pleasure seen my observations confirmed by MM. Ebrard, Schulzer, Guiet, Alaboissette, Pitre-Aubanais, &c., in different memoirs which had been published in the journals. It is very important to recognize the intermittent fever of young children; first, because it is rather frequent, rather serious, and notwithstanding this, however, easy to cure; and secondly, because it furnishes us with a curious example of the modification which age may impress on diseases. In fact, the intermittent fever of children at the breast, which has the same apparent origin and the same appreciable nature as the intermittent fever of older children and adults, differs from it remarkably in its symptoms. It is not at all accompanied by the rigors characteristic of ordinary intermittent fever, and it is never very regular in its paroxysms. This latter circumstance has singularly contributed to throw obscurity over its diagnosis. CAUSES. Intermittent fever is observed, it is said, in the fœtus while yet in its mother's womb. Thus, M. Pitre-Aubanais, states that he has seen two children born of mothers who had had intermittent fever in their pregnancy, and who had considerable hypertrophy of the spleen. Both presented intermittent fever of the tertian type, the fits of which returned at the same hours and at the same days on which the febrile accession th was observed in their mother. M. Jacquemier quotes from Schuriz the case of a woman, pregnant for the third time, who was attacked in the second month of her pregnancy by a very obstinate quartan ague. In the last month of gestation, before or after the paroxysm of her fever, she felt the foetus move, tremble, and manifestly roll from one side to the other, Then, after a strong paroxysm, she was delivered of a daughter, who, at the same hour as the mother, was seized with an attack of very intense fever, which continued for seven weeks. I shall not discuss these instances too extraordinary for implicit sto ague. Wildren inhabiting marshy districts, or in those who have been sent to nurse in these countries. Thus it is very common in the departments of Orleanais and Berri, provinces which furnish a great number of the nurses of Paris. sai I have had the opportunity of observing fifteen cases; four at the Necker Hospital, in the practice of M. Trousseau, and eleven ay in the city. The greatest caution was necessary in order to arrive at a precise diagnosis. SYMPTOMS. Young children attacked with intermittent fever are diminutive, thin, and slightly developed for their age. One of those who fell under my notice was twenty-eight months, and one would hardly have thought it more than six months old. The flesh is soft, the skin is flabby, of a yellowish white, the gums colourless, the belly very large, and the left hypochondrium covers a moveable tumour, rather large, sometimes apparent, and which is formed by the hypertrophied spleen. It is useless to employ percussion in order to define the limits of this organ, for with the state of the emaciation of the children and the slight thickness of the anterior abdominal wall, the spleen forms a projection, and is very decidedly marked beneath the skin. It is observed to change its position at each movement of the child; it may be pushed back and made to disappear at will, by means of pressure of the fingers. It is, then, impossible to mistake this increase of size, and here the eye may advantageously take the place of percussion. This is so far true, that the hypertrophied spleen may be circumscribed, and the position which it occupies beneath the skin, marked with a stick of nitrate of silver. Intermittent fever throws the young children into a state of great cachexia; their limbs become infiltrated with serum, and cutaneous hæmorrhages take place in the skin, true petechiæ, sufficiently large to come under the denomination of purpura hæmorrhagica. The first patient who came under my observation presented these two phenomena of infiltration and of hæmorrhage. It is possible that one day the complement of these morbid states may be met with in patients; that is to say the general serous effusion, together with œdema of the limbs, or the hæmorrhages of the mucous membrane with hæmorrhages of the skin. they 20 Murpure's I have not been able to discover in the heart and in the vessels the r bruits characteristic of anæmia, but it may be conceived that they Cen escaped me. In fact, auscultation of the heart is rather difficult in young children, so that those bruits may have escaped my ear. The examination of the heart agitates the little patient so violently, that it uel a is impossible to derive any advantage from it. Such are the general symptoms which children at the breast present when attacked with intermittent fever. The symptoms of febrile reaction are also well characterised. The fever returns by more or A less violent fits, always very irregular, the health appearing to be of (462 pretty good in the interval, except in a certain number of special complications. RETURN AND DURATION OF FITS. The attacks of fever are very irregular in children at the breast; quia they usually present the quotidian, seldom the tertian type, and they return at hours which are not constantly the same. In the city I once observed the tertian type; but the subject had already attained his second year, and should therefore perhaps be included in the category of children of the second age. A much larger number of cases are necessary in order to establish in an incontestable manner that, in children at the breast, intermittent fever presents the quotidian type. The heat ear The However this may be, the fits are observed every day; they appear at different hours. They present three stages, but one alone is well Comes thi characterized. The rigors, as far as we could make out, were generally h wanting; they are replaced by a sort of concentration of the strength which does not escape the enlightened medical man. which succeeds is very intense; it is the symptom which strikes mothers, and which they point out to the medical man. sweating then manifests itself, but it is not very abundant. When the attack of fever commences, the pulse becomes small, disappears beneath the fingers, and is deficient to such an extent that it is difficult to specify its presence; the face becomes pale, the nose pinched, the lips colourless, the skin contracted, and the nails of a bluish tint. The hands are cold, but the temperature of the breath does not appear to be modified. If the sensation of cold exists, which Only the Stuge man. be prom. է, uzu, A of fluer Ugor 14 mauling |