RÖTHELN

Synonyms.—Rubella; German measles; Epidemic roseola; Hybrid measles;
French measles; Fr., Roséola épidémique.

Definition.—Rubella, or rötheln, is a mild, contagious, eruptive dis­
ease, with a slight febrile action, and usually of but several days’ duration.

Symptoms.—The period of incubation is somewhat variable,
usually, however, from one to three weeks; with a stage of invasion,
frequently but a few hours, scarcely ever exceeding one or two days,
and characterized by slight malaise, enlargement of the cervical glands,
and less frequently the other lymphatic glands, generally insignificant
febrile action, and sometimes with headache and pains in the extremities.
Exceptionally there may be some symptoms of nervous character.
Very often, however, constitutional disturbance, which is rarely marked,
is entirely or apparently wanting, and the first recognizable sign of the
malady is the rash. This may first present upon any part, but much
more commonly on the upper half of the body, and frequently on the
face and scalp, and extends rapidly downward. Sometimes along with
the rash slight catarrhal symptoms are also noted, as mild coryza, injec­
tion of the conjunctiva, with lacrimation and slight redness and soreness
of the fauces. The eruption usually consists of more or less rounded
rosy spots, varying in size from a pin-head to that of a lentil, and which
are made up of closely set points, with trifling but scarcely recognizable
elevation, being macular or maculopapular in character. The color
rarely gets beyond a pale red, never violaceous. Sometimes the tint
extends as a faint halo just a little beyond the border of the actual lesion.
The spots may be somewhat disseminated or more or less crowded, the
eruption seldom covering more than half the surface; it not only spreads
rapidly, but as it spreads the first spots are frequently already disap­
pearing. The rash rarely lasts more than a few days from beginning to
the end. Desquamation is unusual, and when observed, is commonly
of an almost imperceptible branny character. The general symptoms,
if present, are scarcely ever pronounced, the temperature only occasion­
ally going beyond 100° F., and very often it is normal throughout. In
exceptional instances relapse occurs, either immediately or after several
days, but not later than two weeks (Emminghaus).¹ The eruption is

¹ Quoted by Atkinson, Amer. Jour. Med. Sci., Jan., 1887, in an excellent paper on
the disease, giving its history, with numerous references. Relapses were also noted in a
few instances by Harrison, Brit. Jour. Derm., 1892, p. 112, and also by other writers.

ROTHELN

475

not always a clearly distinctive one, as it may resemble both measles
and scarlet fever; as Crozer Griffith¹ states, “the eruption is maculo-
papular, pin-head to split-pea size, pale-rose, multiform, usually discrete,
sometimes grouped as in measles, sometimes confluent as in scarlatina.”
It undoubtedly more frequently bears decided resemblance to measles,
and in considering the points of difference, Atkinson truly says that there
is no feature of either affection that may not be sometimes observed in
the other, whether it belong to the incubative, invasion, eruptive, or
desquamative stages.

The most common subjects of the disease are children, it being most
frequent between the ages of five and fifteen; adults are only rarely
affected. The disease is not thought to recur, one attack giving im­
munity. It is usually epidemic in character, seldom presenting sporadic­
ally, so that reported sporadic cases must be looked upon with consid­
erable doubt, as the possibilities of an erroneous diagnosis are naturally
great. The danger of contagion is believed to be greatest during the
eruptive period.

Diagnosis.—The malady is to be distinguished from measles,
scarlet fever, and the medicinal erythemata. The mildness of the dis­
ease, its short period of invasion, often entirely absent; the rapid develop­
ment and disappearance of the rash, the slight angina and conjunctival
injection; and, as a rule, the absence of a tendency to crescent shape or
to scarlatinous confluence; the slight or lacking febrile action, the en­
larged cervical glands; and the usually almost imperceptible, often
absent, character of the desquamation, are the distinguishing features.
The importance of the glandular enlargement referred to has been em­
phasized by many writers, and while taken together with other factors
is of great value, is not to be given too much weight, as Atkinson, Crozer
Griffith, and others have called attention to the fact that it is very often
observed in measles also.² In typical examples of the malady there is
seldom any difficulty in reaching a correct diagnosis, but in atypical
cases it is only by a careful consideration of the points of difference in
these several febrile eruptive diseases, sometimes supplemented by one
or two days’ observation, that error can be avoided. From the medicinal
rashes there is rarely much trouble in distinguishing it, as these are
usually more pronounced, the eruptions more vivid or dark red, with the
absence of the other symptoms of rötheln, as well as a history of drug
ingestion.

Prognosis and Treatment—The malady is, as a rule, a trivial
affair and is over in the course of several days or a week or so, and there
are not, as often observed in measles and scarlet fever, any sequelæ. It is
true, as in any other disease, complications may arise in this, doubtless
independently of the malady itself, and the outcome would then depend
upon the nature of the complication, a few deaths having been reported
in consequence of such accident. The treatment is purely expectant,

¹ Crozer Griffith (a report of 150 cases), Med. Record, July 2 and 9, 1887 (with full
bibliography).

² Crozer Griffith, “The Differential Diagnosis of Rubeola and Rubella, with Espe­
cial Reference to the Enlargement of the Glands of the Neck,” University Med. Mag.,
Philadelphia, June, 1892.

476

INFLAMMATIONS

and generally none is required. The patient should be kept housed,
and if there is febrile action, in bed, and with a plain diet.

But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy!

Also, please consider sharing our helpful website with your online friends.