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Epidemic Roseola

measles, rash, rotheln, day, sometimes, fever, stage, throat and subsides


roseola, often called rotheln or German measles, is a mild infec tious complaint which bears so close a resemblance to measles that it is in all probability frequently confounded with it. The two diseases are, how ever, not the same, for rotheln does not protect against measles, and is itself often seen to occur in a child who has been lately the subject of that disorder. The complaint is almost always a mild one, and has no compli cations or sequelm.

Symptoms.—The stage of incubation is said to last a week. When the disease begins, the child is seen to lie about and to look poorly. He is slightly feverish and, if old enough, complains of headache. With this there are the usual accompaniments of thirst and want of appetite ; and sometimes a pain in the back has been complained of—violent in character like the back-ache of small-pox. The pre-eruptive stage often lasts only a few hours, or, indeed, may be even absent. Perhaps its average duration may be taken at twenty-four hours. The eruption then conies out on the cheeks, and sides of the nose, as dusky-red slightly elevated papules, the colour of which disappears on pressure. The wrists and ankles are attacked almost as early as the face ; and from these points the rash quickly spreads to the rest of the body and limbs. On the cheeks the rash is more papular than elsewhere. It differs from the eruption of measles in that the spots do not group themselves in crescentic patches ; but resembles it in the tendency of the rash to become confluent in places. Thus a large patch of uniform redness is often seen on the cheeks ; and sometimes we find the same confluence of rash on the wrists and forearms, the legs and the ankles. The eruption is attended with a good deal of irritation, and when it subsides, is followed by a slight fine desquamation.

The general symptoms during this stage are trifling. The fever may persist during the first day or two, but often subsides soon after the ap pearance of the rash. The conjunctivae may be injected, but there is seldom coryza ; and if cough be present, it is insignificant. One almost constant symptom is sore throat. This generally comes on with the rash, and, on inspection, the fauces are found to be the seat of diffused redness ; and the tonsils may be inflamed and swollen. The soreness subsides in a day or two, but after a short interval is apt to return. The secondary sore throat is a characteristic symptom of rotheln. It occurs between the third and seventh day—usually, according to Dr. Tonge-Smith, on the fourth or fifth—and is accompanied by great pain and much swelling. In the severer cases the voice is altered, articulation and deglutition are dis tressing, and there is much secretion of sticky mucus. The temperature at this time may reach 103° or 104°; still, even when the throat symptoms are worst there is no prostration or even any feeling of general illness. Some the glands of the neck are enlarged and tender , and in some epi demics the post-cervical glands have been noticed to be swollen. The

axillary, inguinal glands, etc., may be also affected. The duration of the eruptive stage is three or four days.

An attack of rotheln is then, as a rule, a very insignificant matter. The difficulty is to distinguish it from measles, which it so much resembles. The two chief points of distinction are the shorter period of the eruptive stage in rotheln, and the non-crescentic arrangement of the rash. The milder character of the catarrh will hardly serve as a distinguishing mark, for sometimes in measles the cough and coryza cause little inconvenience to the patient. Another point is the lower temperature. Sometimes in ro theln there seems to be scarcely any fever at all ; and when present, the pyrexia generally subsides on the second day. In spite of these points of contrast between the two complaints, we must often hesitate to express a positive opinion upon a particular case. The absence of any increase of fever when the eruption comes out may afford a suspicion that the cane is not one of true measles, but we can seldom speak with certainty upon the first day of the rash. On the second or third day, however, if we find the general symptoms still retain their trifling character, and if the fever sub sides before the rash has begun to fade, we may conclude the case to be one of rotheln. In doubtful cases the more or less general glandular en largement, especially the swelling of the cervical and suboccipital glands, is a very suspicious symptom ; and the occurrence of secondary sore throat with no actual sense of illness is very suggestive of rotheln.

The disorder has been described as a mild one, but it is right to say that some authorities hold that it may assume a much more severe charac ten Dr. Cheadle, from careful observation of two epidemics, which pre sented all the characters of measles and occurred in succession in the same district within the same year, concluded that the second of these epi demics was rotheln although the symptoms were severe, and the laryngeal phenomena especially well marked. He founded this opinion upon the shorter period of incubation during the second epidemic, and upon the fact that out of thirty cases in which absolutely trustworthy histories could be obtained, twenty-two had had measles before, and ten of these under his own immediate observation within the year. Still, we may re member with regard to this latter point that measles, although as a rule it protects the subject for the future against a similar attack, is perhaps of all the contagious fevers the one most liable to recur. A second or even a third attack in the same individual is far from uncommon, and sometimes the interval between two such attacks is curiously short.

patient must be confined to one room while the fever lasts, and care must be taken that he is not overfed. No medicine is required.