24 DISEASES OF CHILDREN. 



hardened spot, which is perhaps better felt if one finger be applied to the inside and 

 the other to the outside of the cheek. The skin over it is generally red, and the 

 condition is not unlike an angry carbuncle growing in the thickness of the cheek. 

 This swollen patch mortifies or sloughs, and then we get extensive ulceration, with 

 discharge of matter and shreds of core. This ulceration may spread enormously* so 

 that the teeth fall out, and pieces of the jaw-bones loosen and come away. The 

 glands of the neck and under the jaw get very much enlarged. The child but too 

 often dies, the mortality from this alarming complaint equalling seventy-five per cent, 

 of the total cases. Death is brought about either by exhaustion or by blood-poisoning 

 secondary to the local condition. This disease is not due, as has been asserted, to 

 the administration of mercury. 



The treatment must be local and general. For the local treatment very strong 

 measures are necessary, and it is always advisable to have the opinion and assistance 

 of a surgeon. The gangrenous surface of the wound must be destroyed, so as to stop 

 the gangrenous action, and for the effecting of this, strong aquafortis is probably the 

 best application. It must be applied thoroughly and to every spot of the wound, or 

 it may have to be repeated. Disinfectants must be used to cleanse the mouth, and the 

 strength of the child must be supported by every possible means. The strongest soups, 

 beef tea, port wine, arrowroot, and other nourishing and wholesome food, must be 

 given liberally. In a condition like this there need be no hesitation about giving wine 

 even to very young children, as they take it well, and it will certainly do them good. 



German Measles. This may be looked upon as a new disease, and although it 

 has long been recognised by German physicians, it is only of late years that it has 

 been noticed in this country. It is also known by its German name of " Rotheln," 

 and has occasionally been spoken of as hybrid measles or hybrid scarlatina. Sueh 

 names are not good, because they are liable to lead to the false impression that the 

 disease in question is a mixture of measles and scarlatina. The premonitory fever 

 in Rotheln very closely resembles that of measles. There is malaise, headache, loss 

 of appetite, running at the nose, and occasionally a painful condition about the eyes. 

 It is of much less duration than in measles, and lasts generally only twenty-four 

 hours instead of four days. 



The eruption very closely resembles that of measles, but is often more copious, and 

 is liable to coalesce, so that the skin appears uniformly red. The rash, indeed, begins 

 like measles, and ends often like scarlet fever. The eruption lasts a longer time 

 than that of measles, and its duration varies from five to ten days. After its 

 disappearance there is a general peeling of the skin. This is more marked than ever 

 is the case in measles, but is not nearly so pronounced as in scarlet fever. 



The sore throat is always a prominent feature. It is never so severe as the throat 

 affection of scarlet fever, but it is, nevertheless, more severe than that met with in 

 measles, and often endures until the disease has completely run its course. 



The disease is contagious and infectious, but it invariably gives rise to true 

 Rotheln, and not to measles or scarlet fever, as one might suppose from the name 

 hybrid which has been given to it. Neither does Rotheln protect from measles or 

 scarlatina, nor do either of these diseases protect from Rotheln. 



