Rhubarb is an efficient remedy in duo denal catarrh and in catarrh of the biliary ducts with jaundice, especially in chil dren. White, pasty, or clay-colored stools with a skin of an earthy or jaundiced hue are indications for rhubarb.
RUBELLA.—Latin, rubellus, reddish.
Synonyms.—Rotheln, German measles.
Definition.—Rubella is an acute, infec tious, contagious disease of mild charac ter, presenting somewhat variable symp toms and running a favorable course. Its identity as a disease, sui genevis, was long doubted. There is now no question, however, that it is a distinct entity among diseases, though it strongly resembles in its different manifestations measles and scarlet fever. No better statement of present beliefs regarding its true char acter has been made than that of Griffith, which is as follows: "(1) rubella is a con tagious, eruptive fever, and not a simple affection of the skin; (2) it prevails in dependently either of measles or of scar let fever; (3) its incubation, eruption, invasion, and symptoms differ materially from both of these diseases; (4) it attacks indiscriminately and with equal severity those who have had measles and scarlet fever and those who have not, nor does it protect in any degree against either of them; (5) it never produces anything but rubella in those exposed to its contagion; (6) it occurs but once in the individual." Period of Incubation.—The period of incubation given by different authors is as follows: B olt, S to 16 days, the limits being 5 to 22 days; Botch, 21 days; Ed wards, 7 to 14 days; Plant, 1 to 3 weeks; Smith, about 2 weeks. These figures clearly show that the period of incuba tion is of considerable length and ex tremely variable. The indefiniteness arises not so much from lack of observa tion as from variability in the disease. To say that the period of incubation is about two weeks is probably as correct and definite a statement as can be made.
Symptoms.—The symptoms of rubella are extremely variable, so much so in fact that we must agree with Botch that it is impossible to describe a typical case in such a way that the disease can be cer tainly diagnosticated in a sporadic case. Many cases, however, run a fairly con- . sistent and characteristic course. The
invasion is seldom severe. In some cases there is a prodromal stage lasting a few hours; in others the rash is the first symptom to be observed. The fever is rarely high and often does not rise above 100°, but commonly, when at its height, on the first day of the eruption, it reaches 101° or 102°. It occasionally rises to 104° or more. The drowsiness, stupor, and other evidences of serious illness so frequently seen at the height of measles are rarely, if ever, seen in rubella. A child with a bright and very extensive eruption will frequently show no sign of general illness.
The apyrexia which so commonly attends rubella is an altogether-excep tional phenomenon in measles. If, then, a child affected with a measly eruption is apyretic, rubella may be almost cer tainly diagnosed. Juhel-Renoy (Lancet, Nov. 11, '93).
In my own experience, sore throat has been the rule. The tonsils and pharynx are red and swelled and there is pain on swallowing. This is occasionally so marked as to be very suggestive of scar let fever. The vomiting so common at the outset of that disease, however, is rarely present. A secondary sore throat which comes on as the disease is sub siding was first noted by Eustice Smith as very characteristic of rubella. It cer tainly occurs in some cases. The symp toms of the primary angina subside on the second or third day and rapidly dis appear. There are no catarrhal symp toms in most cases, but occasionally slight suffusion of the eyes and a mild catarrh will render the diagnosis from measles more difficult.
Enlargement of the post-cervical and suboccipital glands is a very constant and very characteristic symptom of ru bella. Numerous small glands may al most invariably be felt behind the sterno mastoid well down toward the shoulder; they rarely become very large and never suppurate. They may be felt most dis tinctly when the rash is at its height, and disappear rapidly. While they aid mate rially in diagnosis, and may perhaps be called diagnostic, they are certainly not pathognomonic, for they may sometimes be found in measles and in rare cases may be found in scrofulous children without febrile symptoms.