(German measles; Rubella)
Definition. An acute epidemic, mildly contagious disease, characterized be very slightly elevated, rose-colored macules, slight catarrhal symptoms, slight fever, and lasting usually three or four days.
Symptoms. The incubative period is more variable than that of measles. It may vary from four to twenty-one days. German measles usually occurs in epidemics, sporadic cases being unknown. It is a specific entity not related to measles or scarlet fever and not protecting against attacks of either of these diseases. The prodromes are rare or, if mild, include malaise, headache, articular pains, nausea, and vomiting. Enlargement of the posterior, cervical glands generally occurs but there is usually no fever; if the latter is present, however, it only lasts for a couple of days and seldom goes above 102* F.
The eruption is usually the only real evidence of the disease. It is polymorphic, presenting the appearance of scarlet fever in one part of the surface and measles in another or in the same epidemic, individual patients will present different forms. The eruption first appears on the face and scalp, then on the neck, trunk, upper and lower extremities, in the form of multiple discrete, pin-point to pin-head-sized macules of a rosy or pinkish red, rarely darker. The lesions may become grouped in round or oval patches, but seldom show a crescentic form. The elements of the eruption are apt to remain discrete and disseminated but after complete evolution may be slightly elevated. The entire process fades in from one to five days and there may be slight branny desquamation. The complications and sequelae are few and unimportant.
Etiology and Pathology. The disease is distinctly infectious and contagious, attacks an individual once in a lifetime, and those usually affected are children. It is apt to come in epidemic. It is almost as common as measles but the infection appears to be more persistent and tenacious and is often carried by articles of clothing. The probable parasitic cause of the disease has not been discovered but there is little doubt that it is an animal or vegetable microorganism.
Diagnosis. The appearance of the eruption without prodromes, its mildness, epidemic character, transitory fever, adenopathy, occurrence in children who have had measles or scarlet fever previously, together with the typical eruption, should be sufficient to make the diagnosis. However, gastrointestinal erythemas should be constantly borne in mid. See differential table under rubeola for additional diagnostic points.
Prognosis and Treatment. The disease is benign and runs a quick course in one to two weeks. Deaths only ensue from complications usually affecting the respiratory tract. It is not necessary to insist on rest in bed if the fever or catarrhal symptoms are absent or slight, although quarantine, with an abundant supply of fresh air and the usual fever diet, are necessary to guard the patient against undue exposure or complications. Internal medication may call for the following; Aconite, Apis, Arsenicum iod., Copaiva, Phytolacca, and Sulphur.