SIMULTANEOUS APPEARANCE OF MANY ACUTE EXANTHEMATA The observation of Hebra that the acute exanthemata are antago nistic to one another has been disproved for forty years. Every imagi nable combination of scarlet fever, varicella, measles and vaccination has been noted. Such an occurrence is of clinical interest only when these various exanthemata occur simultaneously.
The recognition of varicella is not difficult.
In two such cases we observed the scarlet fever eruption apparently succeed varicella papules—a secondary infection (Huebner); in one case both eruptions were associated distinctly. Pustulation of the varicella papules invariably occurs.
It is far more difficult to differentiate between the eruption of measles and scarlet fever.
Marie Sch., five years old. Entered hospital without a history. On the first clay the cheeks only were reddened. No eruption was seen in the circumoral region, although it was not very pale. On the trunk appeared a light scarlet fever eruption. Larger spots were seen on the inner side of the arms, with irregular areas of normal skin. Severe con junctivitis, coryza, dry cough, typical measles tongue, Koplik's spots. Reddening and swelling of the tonsils.
On the following day the eruption was morbillous, but a grayish white coating had formed on the tonsils, which eventually developed into a typical scarlet fever angina.
The fever fell by lysis, with simultaneous fading of the eruption; otitis media; later typical scarlet fever desquamation.
We would not advise basing a diagnosis of double infection on the presence of an eruption which might be taken as that of either measles or scarlet fever, because in the case of measles a miliary eruption is often seen here and there on the skin, while in the case of scarlet fever, as has been emphasized elsewhere, a large, morbillous eruption (double exan them) is often seen.
In the case cited above, the diagnosis of scarlet fever was With cer tainty based on the angina and the character of the desquamation, whereas the presence of measles was shown by the appearance of the buccal mucosa (Koplik's spots), and the catarrhal inflammation of the nose and larynx.
It is impossible to determine at this time the correctness of Pos pischills' contention that the stage of eruption of the exanthemata not only is not deterrent, but predisposes to the occurrence of a second infection.