The danger from measles depends almost entirely on its complications.
In any case if fever persists after the rash fades and the patient
does not rapidly improve complications must be suspected. Sometimes
a looseness of the bowels occurs with the onset of measles, but it
usually stops as the eruption comes out. In babies the intestinal
disturbance may continue and grow worse as the disease progresses. This
may become a grave complication in young children. Most often dangerous
complications have to do with the respiratory tract. In small children
there is a special tendency for the inflammation to extend from the
bronchial tubes to the lungs with resulting pneumonia, which is the
most common cause of death. Sometimes the inflammation extends to the
covering of the lungs producing pleurisy. This may become purulent,
and then is known as empyema. In this condition pus collects in the
chest between the lung and the chest wall, causing compression of the
lung. When the pleurisy begins there is pain in the side, but as the
pus accumulates this stops. With the collection of pus in the side
breathing is interfered with and in children especially the side
affected may be seen to be enlarged and to move less than the other
side when the patient breathes. This condition is associated with fever
and sweats, and not infrequently has aroused suspicion of consumption.
Inflammation inside the ear is a frequent complication of measles. The
involvement of the ear follows the passage of infectious material from
the throat through the Eustachian tube. There is first fever and pain
in the ear, which may subside, or after a day or two, a discharge from
the ear appears. The discharge at first is watery and may be tinged
with blood, but it soon becomes thick and purulent. With the appearance
of discharge the pain subsides and the fever disappears. As healing
takes place the discharge again becomes thinner and finally stops.
Sometimes the inflammation extends from the ear to the bone back of
the ear and mastoid disease results. This is recognized by tenderness
on pressing on the bone. When this develops fever returns and the
child appears sicker. With mastoid disease there is always danger of
extension of the inflammation through the bone and the production of
meningitis. Children with measles often have small whitish ulcers in
the mouth, on the lining of the cheek, along the gums and on the edges
and tip of the tongue. These are apt to be sensitive, causing pain when
eating, and associated with profuse flow of saliva. Very rarely these
ulcers become black and there results an extensive ulceration of the
entire face. This occurs only in poorly nourished children, especially
in institutions.
Measles has the property of rendering the patient susceptible to other
contagious diseases. Tuberculosis often progresses rapidly after
measles. This should always be suspected if fever and cough continue
after the rash fades. If diphtheria is contracted during or soon after
measles it runs a particularly virulent course. On the other hand when
measles follows other contagious diseases, especially whooping cough,
it is more fatal. Children with whooping cough should be kept away from
measles with special care.