pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Numbered Diseases of Childhood: Rashes

About the last time I can see that anyone in the field of medicine attempted to make things a bit easier on ourselves was in 1905 when pediatricians tried to describe the six then known diseases which cause rashes by giving them numbers.

After all, unlike today, back then physicians weren’t so much the type of people who were out for glory – and pediatricians even less so. It was only the necessity of talking about a newly described disease around the “water cooler” which required colleagues to credit its “discoverer.”
About as close as doc’s get to a water cooler.
“You hear that ‘ol Clem Dukes thinks this rash on the face is different than Rubella?”
“Really? Well that makes sense and that means that I’ve seen five of Dukes’ diseases this week!”

And frankly, that kind of talk made ‘ol Clem Dukes a bit embarrassed. So, everyone was relieved when a new publication came out proposing numbers – roughly in the order that they were first “described.” First – Rubeola; Second – Scarlet Fever; Third – Rubella; Fourth – Filatov-Dukes’ disease; Fifth – Erythema Infectiosum; and, Sixth – Roseola.

Unfortunately, that wasn’t so much a bad idea as it was completely unmanageable. It was a total underestimation of the thousands of actual diseases which we now know cause rashes AND diseases hardly ever come into existence conveniently all in a row – they are talked and argued about, sometimes for years.

What’s In A Name?

boy with lacey slapped-cheek rash of fifth disease, erythema infectiosum, on faceSlapped cheek appearance of fifth disease.We haven’t eradicated any of them, they’re still around; but, their names have changed – some of them several times. And even good ‘ol “number four” has been lost in translation so badly that no one can agree what it was – or even IF it was! So it has a number but no certain disease to go with it.

About the only vestige that reminds us of the once valiant attempt is that “Erythema Infectiosum” is so hard to write and say (try it 5 times fast), that even the new-fangled-kid docs still call it “fifth’s disease” – although, honestly, many of them think it was invented by “Dr. Fifth!”

When us grey-hairs talk about “the Numbered Diseases” and get all teary-eyed-nostalgic for the “simpler times” we can usually count on one kid doc in the back of the room trying to point out they must have been “dumb as stumps” back then by declaring: “they couldn’t be right – what about Chicken Pox? That’s been around as long as Measles, why wasn’t that numbered?”

It’s usually made by the same spikey-haired fella’ without a tie who calls patients by their first name and thinks there was a Dr. Fifth; so, we need to be tolerant of his naiveté and point out that: “No, that’s not a rash – it’s a pox.”

Simpler Times?

Perhaps it might be just a case of “not knowing what you don’t know”; but, wouldn’t it be great if there were only six children’s diseases to learn and memorize? Ok, seven, giving deference to the kid in the back.

boy with scarlet fever rash - scarlitinaTotal body rash of SECOND diseaseNineteen-O-five, let’s see, what was medicine like back then. For one thing, it was NOT the dark ages that you might think. The New England Journal Of Medicine, a leading and well respected medical journal was already up to VOLUME 152! It began publishing in 1812! [No, I don’t know where the other years went!]

In that year the surgeons were excited about using a new incision to take out an inflamed appendix – the McBurney incision; and the more careful among the group were writing articles like: “Are We Careful In Prescribing Strychnine?”

Smallpox was a known entity and had an available vaccination (1796) – the first vaccine ever developed. So was cholera (1879), rabies (1885), tetanus (1890), typhoid fever (1896) and bubonic plague (1897).

Penicillin had not been invented yet as a drug but a new book was published entitled “Manual of Diseases of Infants and Children” which listed all the diseases of children their possible causes, consequences and ameliorations or treatments – all in one concise volume. Truthfully though, only its descriptions and consequences were its strong points because almost nothing back then had actual known causes and there weren’t many curative treatments.

It wouldn’t be until the war that “second disease,” and perhaps the vanished “fourth disease” would actually get some help. The germ which caused Scarlet Fever could be grown in a laboratory dish and it was known that a certain type of mold would kill it. But the Brits were otherwise occupied in the war so their scientist came to Peoria in the US for help with the research necessary to be able to use it on actual people.

Penicillin was in production so that it could be used on the soldiers of D-Day! And the children of the world finally had help to prevent scarlet and rheumatic fever. Unfortunately, within four years doctors were already seeing bacteria developing resistance to the new drug.

lest we get too pleased with ourselves, it wasn’t clear until 1921 when the vaccine for diphtheria and tuberculosis was developed; 1924 – scarlet fever; 1926 – pertussis (whooping cough); 1945 – influenza; and 1952 – polio. First Disease didn’t have a “cure” (prevention) until 1963 when its vaccine was developed and Third Disease waited till 1970.

The Numbered Diseases Today

The non-“rash” disease called to our attention by the “kid” in the back row, Chicken Pox, didn’t get its vaccine until 1974.

So, should we take a stroll down memory lane and fill in the gaps with what we now know about the Numbered Diseases? We’ll do that in the next couple of articles and begin with FIRST Disease – Measles – not only the one with the longest known history but one at the center of one of the worst medical hoaxes of all time which compromised the health of millions of children.

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