There is one pathognomonic feature eminently distinctive of rubella. It is an enlargement of the small glands just at the edge of the hair on the postero lateral sides of the neck. This feature has never been absent in any case com ing under personal observation. Osborn (Weekly Med. Review, Dec. 24, '87).
Experience recorded in three epi demics of rubella. The eases in the first were almost all typical—the eruption, the fever, the enlarged post-cervical glands, and the slight indisposition pre senting an array of symptoms pathog nomonic of rubella. In the second epi demic there was a close resemblance to measles. The catarrhal symptoms and eruption were very much like measles. The third epidemic closely resembled scarlet fever. J. R. Hillsman (Memphis Med. Monthly, Sept., '92).
Though regarding cervical adenitis as almost pathognomonic of rubella, it was noted in an epidemic of measles in 1886 that 24 out of 27 cases exhibited a glandular enlargement exactly similar to it. Swift ("Reference Hand-book of the Med. Sci.," '92).
The pigmented spots seen in true measles never seen; nor the rose-red spots with the bluish-white speck in the centre seen in measles. The buccal mu cous membrane in most cases of riitheln is of a normal pale-pink hue. The tem perature is highest at the outset, when the eruption has appeared on the face. Enlargement of the lymph-nodes behind the sterno-mastoid muscle personally ob served. Generally, the tonsils are en larged. In varicella the spleen is some times palpably enlarged, but not in r3theln. Scarlet fever does not affect the face so distinctly. The punctate spots in scarlet fever have no particular ar rangement; in rtitheln, if the papules are as small as those of scarlet fever the skin between the papules has a nor mal color. The exanthem of measles of the discrete type closely resembles that of rotheln. The buccal mucous mem brane then becomes the crucial test. The highest temperature reached is 103° F. Henry Koplik (Jour. Amer. Med. Assoc., Nov. 10, 1900).
The eruption appears first upon the face or forehead and extends rapidly over the neck, trunk, and limbs. The whole body is usually covered within twenty-four hours. Occasionally the child will wake in the morning with a rash covering the greater portion of the body. In many cases the rash is limited
not more than twenty-four hours, but, as a rule, it is present from two to four days. Itching is common at the outset.
A slight scaly desquamation may fol to small areas, the greater portion of the body escaping entirely. It is more con stant upon the face than any other re gion. In some cases the rash continues low the disappearance of the rash, but in many cases no desquamation can be de tected. This is particularly true when inunction of the body has been practiced.
The eruption consists of papules or maculo-papules of a red or rose-red color. They vary greatly in size, varying from a pin's-head point to a large blotch. This multiform character is one of the pecul iarities of the eruption of rubella. Most of the spots are smaller than those of measles and larger than those of scarlet fever. They vary in size on different por tions of the body, and even in the same region the rash will be found, as a rule, to be made up of small dots interspersed with larger and irregular-shaped spots or blotches. It lacks the uniformity of the rash seen in scarlet fever or measles. The rash more commonly resembles that of measles and it is frequently impossible to make a diagnosis from it alone. Ed wards has recently alleged that he has not seen the rash resemble that of scarlet fever. That is not my experience. I have frequently seen a rash consisting of small points grouped closely upon a red dened skin that looked extremely like scarlet fever. Search over the body, in such cases, however, will usually reveal small areas of eruption composed of maculo-papules, appearing as large spots. These are commonly found upon the arms, wrists, or hands. I quite agree with those who describe a scarlatina' and a rubeolar type of eruption. I have seen these two types well marked in two chil dren of the same family exposed at the same time, and ill in the same room. The rash of one, consisting of large maculo papules, very strongly resembled measles; that of the other, consisting of much finer points on a reddened skin, as strongly resembled scarlet fever.