Introduction to a discussion on the diagnosis between rubeola and scarlet fever, on May 14th, 1896 / by E.W. Goodall.

  • Goodall, E. W. (Edward Wilberforce), 1861-
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Introduction to a discussion on the diagnosis between rubeola and scarlet fever, on May 14th, 1896 / by E.W. Goodall. Source: Wellcome Collection.

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    In rubeola, the eyes are nearly always suffused ; sometimes there is marked injection of the conjunctival vessels. In scarlet fever the eyes are normal. I have already mentioned that the glands may be found enlarged before the outcome of the rash in rubeola. The glands affected may be the mastoid, posterior cervical, axillary, inguinal, and a gland just above the internal condyle at the elbow. But while it is common to get some or all of these glands enlarged in rubeola, one occasionally but certainly meets with cases in which there is no glandular enlarge¬ ment whatever. Moreover, these glands may be affected in measles, and, less frequently, in scarlet fever, even in mild cases. The glands have been described as being moderately enlarged, hard, and slightly tender in rubeola. But this very condition is occasionally met with in measles and scarlet fever. Hence I am not accustomed to lay much stress on the presence or character of glandular enlargement. Prom a consideration of the temperature and general symptoms little, if any, indication of the nature of the disease is to be obtained. In rubeola the temperature may be up to 104° or 105° P. without the patient being any the worse. It comes to this, therefore, that in the diagnosis between rubeola and mild cases of scarlet fever during the eruptive stage, we have chiefly to rely upon the character and distribution of the rash, including the circumoral ring; less helpful, because less constant, are the condition of the tongue, glands, temperature and pulse. Of the period of convalescence the most striking and constant phenomenon in scarlet fever is desquamation. This begins within three weeks from the rash. It is present even when the rash has been slight and ill-marked. It commences nearly always in minute white elevations, like miliaria ; the tops of the elevations are rubbed off and broken and an appearance of small rings is produced. By a further separation of the superficial epithelial cells these rings enlarge and coalesce to form irregular figures. Where the skin is thick this