St. Kilda: Its Inhabitants and the Diseases Peculiar to Them
Authors: C. R. MacDonald
Journal: BMJ (1886)

IN the chapter on Rothelu oontained in his fine work on Medicine, the late Dr. Fagge; urges the disdiepancios of stattement which occur, even in moaern writings, "co4cerning the suipposed ihird exanthen;" as an argument against the view tiat the d$sease is distinct from measles.,He points out that Trousqeau insists on (the absence of catarrh' during the prodromal stage, while Thomas insists on its presenc6; that Thomas makes the duratioia of this stage (if not absent altogether) two to twelvo hours, and Trousseau one to four days; that Trousseau and Vogel make the rash give rise to intense itching, while Thomas declares this to be seldom the case.The following condensed record of, tWo cases, in which, in spite of considerable differences, in the symptoms, there could be no reasonable doubt that the patients were sufferers from the same disea e, may be of interest as showing 'that the force of objeetions based on such dis- crepancies may easily be overrated.CASE I -On February 24th, I was called to see a yoilng lady who had that afternoon found a rash upon her skin.!' There was a clear history of a previous attack of measles some years ago.Before Feb- ruary 24th, there had been no rece'nt headache, sore-throat, or coryza.The patient had spent the dayin sight-seeing, denied any sense of illness whatever, anld wag only anxious for medical advice from a fear that the rash " tnight mean sonmething infectious.' When' first seen at 11 P.M., the rash referred to was found to be most abundantly developed over the prominent parts of the cheeks.The forehead was less thickly covered, and tEe region nearest the roots of the hair almost free from it.''The rash consisted of small spots, distinctly raised, and with but little surrounding arepla.They' were nowhere confluent, of a pale rose colour, with the intervening skin generally clear, only somewhat flushed where spots were most aiundant.',There was no fulness about the eyelids and a complete absence of the blotchy, puffy appe-arance of meases.The spots were very numerous about the neck and shoulders, and more thinly scattered about the arms.There was diffused redness of the soft palate and pillars of the fauces, and little or no enlargement of the tonsils There was a slightly enlarged gland each side at the angle of the jaw.The glands in the posterior triangle and the suboccipital glands were enlarged on each side..The pulse was 80, and the temperature 99.4'.After two or three days, during which the temperature was normal, and no sign of ill-health showed itself, the patient began to experience some soreness of thiroat, together with a frequent hacking cough.These symptoms lasted a few days only.The glands in the neck became slightly tender, and then subsided, and in ten days from the appearance of the rash were no longer recognisable.No desquamation was'seen at any time.CASE II.-The elder sister of the above was said not to have had measles.On February 24th, this patient was living with her, sister and had, in fact, been sharing her bed.That night, however, she slept elsewhere, and next day left the house for a visit to some friends