Milford chronicle., 1908-02-14

don Edition, published in 1850. thlnK
1t will prove interesting know it will
prove instructive quote from this
author rather than later work because
the chapter perfectly describes our pres
ent epidemic. 1 will not add q word to
reinforce the description, leaving 1t
solely as the positive side of the srgu'
ment.
CHAPTER X.
ROTHELN-RUBEOLA -NOTHA-GERMAN
MEASLES.
It is necessary to consider briefly an aHec-
ton to which the above names have been ap-
piled, the existence OF which is by no means
sufficiently recognized in this country.
ETIoLoeY.-ROtheln has been regarded
either as a mild form Of measles or scarlatinai
or as a combination OF these two diseases ana
hencs termed hybrid measles or hybrid sedrtdtiHd'
There is abundant proof, however, that II Is
quite distinct from both these complaints,
though resembling them in many Of It's fea-
lures, and that 1t is undoubtedly an indePen-
dent acute specific JIeucr, propagated by specinc
contagium. DR.. Robert Livelng believes that
rotheln is far less contagious than either
measles or scarlatina, but that 1t is more dis
distinctly epidemic, at least in this country
even than ordinary measles, and certainly
more so than scarlatlna. The cOntagium prob
ably comes of in the breath and cutaneous
exhalations. Adults may be attacked as we'll
as children.
SYMPToMs.-I. Incubation Stdge.-This usually
lasts about twelve days, but may extend to
twenty days. There are no symptoms.
2 Inrdsina StGge.-RothelE is ushered in with
slight shiverings, pains about the body and
limbs, and pyrexia, while sore throat is almost
always complained Of which differs from that
OF scarlatina In being much less severe, the
local Inflammation very seldom going on to
liberation. In many cases, but not nearly so
frequently, signs OF catarrh are present, such
as are observed In measles. The intensity OF
the symptoms is generally comparatively mild
and not uncOmmonly they are quite insignia
cant, though, on the other hand, they may be
rather severe, the temperature running up to
1890 or more in some instances.
s. ErupeioR Stdge-The eruption OF rotheln,
which Is in the form OF q rash, comes out gem
orally on the second day or even within the
first tweniy-four hours; II may be delayed,
however, until the third or fourth day. It's
amount is usually In proportion TO the inten'
city of the early symptoms. 1t appears mere
or less simultaneously over the body, but Is
less marked on the limbs than elsewhere. AT
first the rash resembles that Of measles. con-
sisting OF a number OF minute red papues.
which become grouped in patches but these
are more irregular and less distinctly erescen-
tic than those observed in measles. The color
is also rather brighter than In this disease, and
Il is deeper at the centre than towards the cir
cumference OF the patches. In some Instances
these cOalesce either partially or completely
so that the SKIN is uniformly red over greater
or less extent OF surface, and then the rash be-
comes more like that OF scarlatina, its dura-
ton being never less than four or i've days,
and It may continue for eight or ten days.
Slight desquamatiOn OF the cuticle follows.
but this is never q prominent feature, being
merely of furfuraceeus character. When the
rash appears, the general symptoms abate
considerably In most cases, but the sore throat
pers lists, being ofteH the last symptom COM
planned Of and continuing sometimes for sew
eral days after the rash has disappeared.
Rotheln seems to be unattended by any par
ticuar complications or sequels as a rule. Slight
albuminuria is not uncommon, but 1t soon
passes away. In rare instances acute renal
disease with drOpsy sets In.
PRoGNosIs.-This is highly favorable, death
from rOtheln being an exceedingly rare event,
while recovery is usually speedy and complete.
Now let me give the lightest touch of
the artists pencil to this almost perfect
picture, if it needs a stroke at all. copy
the few lines below from NOthnagels
Encyclopedia of Medicine, 1902, page
637. attributed to the Archives Of Ped
iatrics":-
"Thst form OF German Measles
which Stimulates mild scarlet fever
derives great interest from the posi-
bility OF its confession under various
circumstances with scarlet fever.
DesquamatiOn may be prOfuse and
out Of all proportion to the severity
Of the rash. 1t differs from scarla.
tina in having a much longer incu-
baton period and in the absence Of
Notwithstanding, high pulse
and severe angina. The eruption
usually begins upon the face ;Other-
wise it appears to differ in nOwise
from the scarlatina eXanthem.
Generally speaking it is quite des-
titute Of all toxic reaction"
We cOnnot judge a disease by single
symptom, we must take the ensemble
and so in an epidemic we can not judge
by extremes. The mildest cases Of Oul
present epidemic might easily be referred
to disordered digestion. and the sever
est ones, isolated, might, possibly, be
called scarlet fever. But this would not
be satisfactory to q seeking, anxious
mind, it would afford no real knowledge
Of the epidemic. 1t is the typical cases
that classify disease, and the atypical
must be judged by them. Having seen
typical cases of Rotheln during the
epidemic, without fever, even in the
initiative, with catarrhal symptoms,
with discrete eruption, with furfurace'
Gus desquamation, the lightest possible
in many cases none, 1 have judged and
classified the atypical as the same dis
ease, believing in the one epidemic.
The whole history Of the epidemic
from it's initiative to the present, only
strengthens and confirms my original
| Judgment, and l can only say to the
/ alaxan ohsfin ofa iurOrs that in the Dree.