Its progress is marked by several stages more or less sharply defined.
After the reception of the contagion into the system, there follows a
period of incubation or latency during which scarcely any disturbance of
the health is perceptible. This period generally lasts 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. At this stage
minute white spots in the buccal mucous membrane frequently occur; when
they do, they are diagnostic of the disease. 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 expectoration, hoarseness of the voice, and
occasionally sickness and diarrhoea, are the chief local phenomena of
this stage. With these there is well-marked febrile disturbance, the
temperature being elevated (102°-104° F.), and the pulse rapid, while
headache, thirst, and restlessness are usually present. In some
instances, these initial symptoms are slight, 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, just like flea-bites, slightly elevated above the
surface, at first isolated, but tending to become grouped 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 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. 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. Usually
during convalescence slight peeling of the epidermis takes place, but
much less distinctly than is the case in scarlet fever. At the
commencement of the eruptive stage the fever, catarrh, and other
constitutional disturbance, which were present from the beginning,
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