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637. This eruptive fever, from its commence ment, is always attended with hoarseness, with a frequent hoarse dry cough, and frequently with some difficultly of breathing. At the same time, the eye-lids are somewhat swelled, the eyes are a little inflamed, and pour out tears; and together with these symptoms, there is a coryza, and fre. quent sneezing. For the most part, a constant drowsiness attends the beginning of this disease.
638. The eruption, as we have said, commonly appears upon the fourth day, first on the face, and successively on the lower parts of the body. It discovers itself first in small red points; but, soon after, a number of these appear in clusters, which do not rise into visible pimples, but by the touch are found to be a little prominent. This is the case on the face; but on other parts of the body, the prominence, or roughness, is hardly to be per. ceived. On the face the eruption retains its red. ness, or has that increased for two days : but, on the third, the vivid redness is changed to a brownish red : and, in a day or two more, the eruption entirely disappears, while a meally desquamation takes place. During the whole time of the erupțion, the face is somewhat turgid, but seldom con: siderably swelled.
639. Sometimes, after the eruption has appear: ed, the fever ceases entirely; but this is seldom
the case; and more commonly the fever continues, or is increased after the eruption, and does not cease till after the desquamation. Even then the fever does not always cease, but continues with various duration and effect.
640. Though the fever happen to cease, upon the eruption's taking place, it is common for the cough to continue till after the desquamation, and sometimes much longer.
In all cases, while the fever continues, the cough also continues, generally with an increase of the difficulty of breathing; and both of these symptoms sometimes arise to a degree that denotes a pneumonic affection. This may arise at any period of the disease ; but very often it does not come on till after the desquamation of the eruption. . .
After the same period, also, a diarrhæa frequent. ly comes on, and continues for some time.
641. It is common for the measles, even when they have not been of a violent kind, to be succeeded by inflammatory affections, particularly ophthalmia and phthisis.
642. If the blood be drawn from a vein during the measles, with the circumstances necessary to favour the separation of the gluten, this always appears separated, and lying on the surface of the crassamentum, as in inflammatory diseases.
643. For the most part the measles, even when violent, are without any putrid tendency; but in some cases such a tendency appears, both in the course of the disease, and especially after the ordinary course of it is finished. See Dr. Wats son, in London Medical Observations, Vol. IV, Art. xi.
.. 644. From what is delivered, from 637 to 642, it will appear, that the measles are distinguished by a catarrhal affection, and by an inflammatory diathesis, to a considerable degree; and therefore the danger attending them arises chiefly from the coming on of a pneumonic inflammation.
645. From this consideration it will be obvious, that the remedies especially necessary, are those which may obviate and diminish the inflammatory diathesis ; and therefore, in a particular manner, blood-letting. This remedy may be employed at any time in the course of the disease, or after its ordinary course is finished. It is to be employed, more or less, according to the urgency of the symptoms of fever, cough, and dyspnea; and generally may be employed very freely. But, as the symptoms of pneumonic inflammation seldom come on during the eruptive fever; and, as this fever is sometimes violent immediately before the eruption, though a sufficiently mild disease be to follow; so bleeding is seldom very necessary during the
eruptive fever, and may often be reserved for the periods of greater danger which are perhaps to ensue.
646. In all cases of measles, where there are no marks of putrescency, and where there is no reason, from the known nature of the epidemic, to apprehend putrescency, bleeding is the remedy to be depended upon : but assistance may also be obtained from cooling purgatives; and particularly from blistering on the sides, or between the shoulders.
647. The dry cough may be alleviated by the large use of demulcent pectorals, mucilaginous, oily, or sweet. It may, however be observed, with respect to these demulcents, that they are not so: powerful in involving and correcting the acrimony of the mass of blood as has been imagined ; and that their chief operation is by besmearing the fauces, and thereby defending them from the irritation of acrids, either arising from the lungs, or distilling from the head.
648. For moderating and quieting the cough in this disease, opiates certainly prove the most ef. fectual means, whenever they can be safely employed. In the measles, in which an inflammatory state prevails in a considerable degree, opiates may
be supposed to be inadmissible; and, in those cases in which a high degree of pyrexia and dyspnea shew either the presence, or at least the danger, of pneumonic inflammation, I think that opiates might be very hurtful. In cases, however, in which the dispnoa is not considerable, and where bleed. ing, to obviate or abate the inflammatory state, has been duly employed, and where the cough and watchfulness are the urgent symptoms, I think that opiates may be safely exhibited, and with great advantage.
I think, further, that, in all the exanthemata, there is an acrimony diffused over the system, which gives a considerable irritation : and, for obviating the effects of this, opiates are useful, and always proper, when no particular contra-indication pre. vails. .
649. When the desquamation of the measles is finished, though there should then be no disorder remaining, physicians have thought it necessary to purge the patient several times, with a view to · draw off the dregs of this disease, that is, a por.
tion of the morbific matter which is supposed to remain long in the body. I cannot reject the sup. position; but, at the same time, cannot believe, that the remains of the morbific matter, diffused over the whole mass of blood, can be entirely drawn off by purging; and it appears to me, that,