Rubella.
Synonyms:—German measles; rötheln; epidemic measles; epidemic roseola; rubeola notha; hybrid scarlet fever.
Definition:—An acute, mild, contagious disease of childhood, often mistaken for measles proper, characterized by a mild fever, an eruption and a swelling of the lymphatic glands of the neck. It is usually epidemic and occasionally endemic.
Etiology:—The exact cause of the disease is unknown, no specific micro-organism having been isolated. It is conveyed by contact and by fomites and also through the air. Nearly three-fourths of all children exposed will contract the disease. It is entirely distinct and independent from measles proper, and a child may have both of these diseases within a few weeks' time, one following the other immediately.
Symptoms:—The period of incubation lasts from nine to twelve days, but the premonitory symptoms are not pronounced in character. Unlike measles proper, the rash may appear as the first conspicuous symptom, although usually malaise, indisposition, chilliness, headache and a mild fever are all present for two days at least before the appearance of the rash, and also a mild nasal catarrh, with sneezing. This is called rose rash. Often it appears on the forehead, cheeks and chest in the order specified on the third and fourth days, and characteristic rose red spots on the hard palate are seen preceding its appearance on the skin. The temperature increases preceding the appearance of the rash, with marked chilliness. The cervical glands become enlarged, irritated and somewhat painful. The eruption is at first papular, the skin then becomes red, almost scarlet, similar to the diffused redness of scarlet fever, but not as deeply red, and is not erased by pressure. Later the eruption appears like a diffused rash and does not occur in concentric masses as in measles proper. It is seldom uniformly bright on all the surface of the body at the same time, but it fades in the order of its appearance, the early areas fading, while those later are just appearing. The rash persists about three days and then disappears, with a slight desquamation. There is not as marked discoloration of the skin as in measles proper—not that distinct roughened, dull, mottled appearance. The throat is sore almost from the first and usually demands special treatment.
Notwithstanding the symptoms described, the disease is often so mild that the physician is not consulted and the child is permitted to play about the house. Unless the disease appears in severe weather and the child is unduly exposed, the danger of complications is not great. Bronchial catarrh, and even a severe gastric or intestinal catarrh, may follow even mild cases. Glandular induration may persist, or in isolated cases glandular abscess may result. Relapses, as severe as the original attack, may occur.
Diagnosis:—The diagnosis is made by the presence of an epidemic; by the appearance of the disease in patients known to have had measles proper; by the mildness of the nasal symptoms, and early appearance of the eruption, the marked glandular complications, and more positively by the characteristic rash, which, once seen, is always recognized. It is distinguished from scarlet fever by the absence of vomiting, the absence of severe constitutional symptoms and the strawberry tongue, and by the rash, which is erythematous and not papular in scarlet fever. With all these differential points a diagnosis is not always positively made at first.
Prognosis:—The prognosis is good. Death seldom, if ever, occurs from positively uncomplicated cases. Bronchial inflammation, or pneumonia, from subsequent exposure, may be difficult of treatment. The throat symptoms may become severe and hard to manage, and diphtheria has followed in a few reported cases. Complications, however, are by no means as common as with measles proper.
Treatment:—The symptoms will quickly suggest the needed remedy. Aconite will meet the first indication, and given in conjunction with belladonna only good will result. Phytolacca, from fifteen to thirty minims in four ounces of water, should be given in dram doses every two hours from the start and continued into convalescence. The glandular symptoms demand this. Minute doses of ammonium muriate and the syrup of ipecac may be given early for bronchial irritation. The former remedy will facilitate the appearance of the eruption. The skin should be anointed with cocoa butter through the period of convalescence. It is seldom other remedies are needed. The condition of the stomach and bowels should be watched and only mild un-irritating nutritious food given. In convalescence minute doses of quinin and hydrastis should be given in a capsule to children above five years of age. One-fourth of a grain of the carbonate of iron may be added to this with advantage. If glandular induration persist, potassium iodid or acetate should be given with phytolacca and echinacea.
