Posted by: Bystander PJ13 MAR 2013
I recently mentioned erythema infectiosum, which in the early 20th century was known as fifth disease because it was the fifth cause of childhood rash and fever to be characterised — after measles, scarlet fever, rubella and Dukes disease and before roseola (PJ, 2 February 2013, p123).
The odd one out in this list is Dukes disease or fourth disease. It was first described in 1885 by an aristocratic Russian physician, Nil Filatov. Then an English doctor, Clement Dukes, who was medical officer at Rugby School, studied the condition in schoolchildren, and in 1900 The Lancet published his article “On the confusion of two different diseases under the name of rubella (rose-rash)”.
The newly characterised fourth disease was widely accepted by the medical community. The early 20th century medical literature carried numerous descriptions of individual cases, outbreaks and laboratory studies.
The condition acquired a variety of names, including Dukes disease, Filatov-Dukes disease, Filatov disease, parascarlatina, scarlatinella and scarlatinoid. However, unlike the other five classical childhood diseases, it was never conclusively proved to exist. No specific causative agent was isolated and no convincing epidemiological criteria were identified. By the 1930s, it was rarely mentioned and by the 1960s it had been quietly dropped from medical textbooks.
About 20 years ago, two US researchers, David M. Morens and Alan R. Katz, decided to
re-evaluate the 1892–1900 data upon which Clement Dukes had based his claim. They deduced that all the cases described could be dismissed as misdiagnosed rubella or scarlet fever. They concluded: “Misidentification of fourth disease is attributed to failures in the critical abilities of the medical and scientific communities at the time.”
Nevertheless, their findings have not been universally accepted. Some reference sources still list fourth disease as a distinct condition