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rash, temperature, eruption, spots, measles, usually, slight and child


Roseola, or the rose rash, is a form of erythema which is often seen in early life, and although a very trifling complaint, is yet on account of the resemblance it bears to measles of some clinical importance.

The rash is especially common in the spring and the autumn, and this partiality to certain seasons of the year has given rise to the names of roseola stiva and roseola autumnalis. Like the other forms of erythema the complaint is not contagious. It is common for one child of a family to be the only one attacked, although mixing freely with the others, and 'exposed to exactly the same conditions. The rash may occur several times in the same individual, for it is in no way self-protective ; indeed, the con trary seems to be the case, and its tendency rather is to recur.

The causes of the complaint appear to be digestive derangement and slight chills. The eruption occasionally complicates other diseases. Thus, it may come on in the pre-eruptive stage of small-pox, and is apt to occur in vaccinated children, and in rheumatic subjects.

appearance of the rash is usually preceded by slight signs of disturbance. The child's eyes look heavy, his appetite is poor, his tongue is furred, and sometimes he vomits. In rarer cases the bowels are slightly loose. It is said that at this time there may be slight eleva •ion of temperature. The pre-eruptive stage lasts usually for a few hours. The rash then appears as bright rose spots, which come out very rapidly, and soon cover large surfaces of the body. The size of these spots is very much that of the eruption of measles ; and sometimes, as in that disease, they assume a crescentic arrangement, so that except for the much brighter colour of the rash the general appearance of the child is that of one suf fering from measles. There are, however, no catarrhal symptoms of any moment ; the throat is seldom reddened, and there is no cough.

The rash lasts a few hours or a day or two, and then subsides. 'Usually, if it has appeared quickly, it fades with some suddenness ; but if it has come out slowly, spreading gradually over the body, it disappears in an equally leisurely manner. Sometimes the eruption appears in the form of small circular spots which remain isolated or joined irregularly ; and in some cases the rash bears a close resemblance to that form of scarlatina in which the spots remain discrete, so as to be separated by skin of healthy colour ing. During the eruptive stage the temperature rarely rises above the normal level.

A little girl of eight years old, the only daughter of very careful parents, was said to have been perfectly well without any sign of catarrh or other disturbance until noon on March 18th. It was then noticed that her eyes

were heavy, but she ate her dinner as usual. In putting the child to bed in the evening it was found that she had some red spots on the shoulder. During the night she sneezed once or twice. On the morning of the fol lowing day the face and body were covered with a crescentic rash which bore a close resemblance to the eruption of measles. It differed only in colour, for the tint was peculiarly bright and rosy. On the cheeks the rash was confluent, and it was rather popular on the jaws. There was very slight injection of the but the fauces were not reddened. The child did hot cough or snuffle, and there was no rhonchus or other abnormal sign about the lungs. A painless, movable gland, the size of a filbert, was felt just below the occiput. The bowels were not relaxed. There was uo special thirst or loss of appetite. The temperature at 2 P.m. was 99°. Pulse, 100.

The next day (March 20th) the rash was fading fast. The temperature was normal. No catarrhal symptoms.

Sometimes the roseolous eruption comes and goes with great rapidity, lasting only a few hours. In such cases it usually readily recurs. The spots sometimes group themselves in rings. This arrangement is held to constitute a special variety—roseola annulata.

Diagnosis.—Roseola, when it assumes the crescentic form, is distin guished from measles by the absence of lengthened prodromata ; by the colour of the rash which, instead of being yellowish-reel or dull reel, is of • a bright rose tint ; by the normal or only moderately elevated temperature, and by the absence of cough and coryza. These points are well illustrated by the case above narrated. It is more difficult to distinguish the com plaint from rOtheln ; for in both disorders the eruption appears early with only slight prodromata, and the temperature soon becomes normal. In rotheln, however, there is a sensible elevation of the temperature during the first day or two ; the soreness of throat, which is almost absent in rose ola, is a marked feature, and the eruption is -dull red with none of the bright rosy tint of the roseolous rash. Still, in spite of these differences the resemblance between the two complaints is sufficiently close to make it probable that rbseola is often called rEitheln, and that the patient is sup posed to have had an attack of " German measles." The diagnosis between roseola and scarlatina is given elsewhere (see page 42).

Treat ment. —The treatment required for roseola consists in keeping the child quiet, and attending to any digestive derangement which may be present. Usually no medicine is necessary.