(GERMAN MEASLES; RUBEOLA NOTHA; ROTHELN; EPIDEMIC ROSEOLA)
=Definition.=—A specific acute, contagious, infectious, eruptive
disease, characterized by a diffuse maculopapular eruption and swelling
of the superficial lymphatic glands. It is attended by a mild fever,
suffused eyes, mild cough, slight sore throat but no catarrh, a macular
rose-red eruption of the throat accompanied by the swelling of the
cervical lymph glands and by a rose-red eruption of irregular size and
shape appearing on the first day of the disease.
Rubella, in some ways, resembles scarlet fever and also measles and was
at one time considered a hybrid of the two. It is now known to be an
independent disease.
=Etiology.=—The exciting cause, or the infective principle, has not
yet been discovered. The disease is probably carried by fomites, is
readily transmissible, attacks children especially, and usually occurs
in epidemics, though sporadic cases are frequently found. The epidemics
usually occur at intervals with several years intervening, during
which time there are comparatively few cases. Persons of all ages are
susceptible unless having acquired an immunity through an attack of the
disease at some former time. Rubella does not confer immunity against
any other disease, as scarlet fever or measles, nor do these diseases
confer immunity against rubella. One attack of rubella confers immunity
against any succeeding attacks.
The incubation period is from five to twenty-one days and is without
symptoms.
The predisposing factors are the same as in measles or other infectious
or contagious diseases.
=Symptoms.=—=Invasion Period.= This stage is usually of very short
duration, lasting from a few hours to perhaps two days. The initial
symptoms are usually mild, being a sudden chilliness, but not chills;
mild fever of about 100 degrees; a slight headache; mild sore throat;
swollen cervical and post auricular lymphatic glands; little or no
coryza; sometimes slight pains in the back and legs; and the macular
rose-red eruption in the throat which is constantly present. Often the
initial symptoms are so mild that the presence of a disease is not
recognized until the eruption appears, which usually occurs on the
first day and rarely not until the fourth day.
=Eruption Period.=—The rash, which consists of round or oval reddish
spots about the size of a split pea, mostly discrete, but sometimes
confluent, and surrounded by areas of hyperemic skin, usually shows
first upon the face and follows a wavelike progression over the body
and limbs. The rash usually begins to fade upon the face before it
has appeared upon the last affected areas, and usually remains in one
region from a few hours to a half day. It extends over the entire
body in from twenty-four to thirty hours. Occasionally the skin is so
hyperemic in extensive tracts that the rash more resembles scarlet
fever rather than measles. The crescentic arrangement of the papules
usually seen in measles can not be made out in rubella. In the course
of two or three days the rash disappears with very fine desquamation,
leaving a faint pigmentation, which remains for a short time. Slight
etching usually accompanies the rash.
Relapses are rare and complications infrequent. There are no special
sequelæ, but albuminuria, bronchitis and pneumonia have been noted.
Although one attack usually confers immunity, second attacks have been
reported, which may have been real second attacks or the first attack
may have been an error in diagnosis.
=Diagnosis.=—Early or sporadic cases may present great difficulty in
diagnosis, but when an epidemic is present diagnosis becomes much
easier. The =direct= diagnosis of the disease rests upon the very mild
nature of the disease, its short initial onset, the character of the
eruptions and the early enlargement of the glands with the absence of
severe throat symptoms and coryza.
Rubella is frequently mistaken for mild cases of measles or scarlet
fever. Unlike measles, it does not have the prominent catarrhal
symptoms, the higher fever, the crescentic grouping of the eruption and
Koplik’s sign. In measles the adenitis is not so severe as in rubella,
and especially are the suboccipital and post-auricular glands involved
in rubella. Scarlet fever has a very sudden onset with severe symptoms,
a very sore throat, the characteristic tongue and the peculiar rash,
all of which are decidedly different from rubella. In the latter stages
the character of the desquamation is also a distinguishing feature.
=Treatment.=—Patient should be kept in a properly heated and well
ventilated room, being careful that no draughts chill the patient, and
should remain in bed for at least two days. Patient should be isolated.
Treatment should be directed to the upper cervical, mid-dorsal and
lower dorsal areas to keep normal the function of the internal
secreting mechanism, and to normalize and keep normal the respiratory
and circulatory systems. Treat carefully to upper lymphatics, working
around the enlarged glands and not directly over them. Watch the
excretory functions and keep them active by judicious measures. If
annoying itching occurs, the hot bath followed by being wrapped in a
soft warm blanket will usually relieve. Daily tepid sponging should
be given and if hot bath does not relieve itching an application of
olive oil or cold cream will often relieve. Diet should be reduced and
regulated according to age of patient and severity of the case. Usually
the above is all that is indicated, but if more severe symptoms present
themselves vary your treatment according to the symptoms present.
=Prognosis.=—Recovery is the general rule. Relapses sometimes occur,
and are usually much more severe than the initial attack. The symptoms
are often more severe in adults than in children. Like measles, this
disease seems to lower resistance to other infections, and therefore
especial care should be taken to protect the patient from exposure to
other diseases for some time after recovery from rubella. See that the
patient is built up constitutionally after recovery by plenty of fresh
air, suitable exercises and good food.