Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Non-existent disease?

  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

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

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

From: Beyond pharmacy blog

Take a look here for thoughts and musings beyond the pharmacy realm

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.