Supplementary Appendix The Understanding of Rötheln ca. 1810

The Understanding of Rötheln ca. 1810

Here a contemporary illustration of the illness (measles, rubeola, Germ Masern) in children (Robert Willan, Die Hautkrankheiten und ihre Behandlung: Systematisch beschrieben, vol. 3, part 1, trans. Friedrich Gotthelf Friese [Breslau 1806], plate xxi):


Germ. Rötheln is defined in 1809 in Johann Christoph Adelung The New and Complete Dictionary of the German and English Languages, composed chiefly after the German Dictionaries of Mr. Adelung and of Mr. Schwan, 3 vols. (Leipzig 1796–99), 2:892 s.v., as: “die Rötheln, the measles, distemper, which bears a near resemblance to the small pox.” Adelung, s.v., otherwise points out that Rötheln is merely a geographically specific designation for Masern, measles, in some dialects other than High German.

The Windischmann children may simply have been suffering from childhood measles, German measles, or rubella. John James Watt describes how the disease “rubeola” or “measles” was understood in England at the time (Medical Dictionary: Containing an Explanation of the Terms in Surgery, Medicine, Midwifery, Anatomy, Chemistry, &c. &c. &c, 2nd ed. [London 1813], s.v. rubeola, n.p.):

Rubeola.The measles. This disease usually attacks individuals only once during life. It commences with febrile affection, difficult breathing, dry cough, heaviness, &c. for several days; before the eruption takes place, a watery discharge from the eyes and nose, and frequent sneezing; these symptoms generally last till the third or fourth day, and sometimes considerably later, when the eruption makes its appearance, which first begins upon the forehead and face in little points causing a great roughness, these gradually extend themselves to other parts of the body, as the breast, back, arms, thighs, legs, &c. in some parts they run together and form irregular blotches like a stain; as the eruption commences the fever generally subsides, but sometimes continues its ravages. In the latter stage of the complaint affections of the lungs may come on and lay the foundation of phthisis pulmonalis. Sometimes the fever has a tendency to take on the characters of typhus, and then it goes by the name of putrid measles, and when there is an inflammatory affectron of the throat by the name of rubeola anginosa. In the treatment of this disorder during the inflammatory stage, bleeding may be necessary according to the violence of the symptoms, but if there exist any of the typhoid characters, this would be highly improper except locally used, in such a case you would prefer other more gentle evacuants, as mild purgatives, glysters, &c. Blisters are extremely useful if the lungs are affected, with the use of saline medicines, emulsions, and linctuses. Antimonial and diuretic medicines prove beneficial, with abstinence from all kinds of stimulants during the inflammatory stage; the patient should take plentifully of diluents, and be kept quiet in a moderate temperature. When the disease becomes of the typhoid kind, bark and other stimulants are then indicated as in typhus.

A bit later in Germany, in 1826, Johann Nepomuk von Raimann, Handbuch Der speciellen medicinischen Pathologie und Therapie für akademische Vorlesungen bearbeitet, 2 vols., 3rd ed. (Vienna 1826), p. 77–79, treats Rötheln under “skin eruptions,” “reddish acute skin eruptions,” and as the third type after (1) contagious typhus and (2) purple of scarlet fever (scarlatina):

§ 674.

Rötheln (Ritteln, Feurmasern [fire measles], also called Red Dog, rubeolae, roseolae, rosalia), although classified by Drs. Kapp, Wichmann, and several other physicians as a type of acute eruptive illness or rash, is considered by most to be merely a subtype either of scarlet fever, measles (so Drs. Ueberlacher, Jahn), or merely of scarlet fever itself (so Drs. Formey, Heim, Hufeland). According to Dr. Reil (Memor. clin. v.ii., par. 12), it allegedly stands between scarlet fever and measles, while inclining more toward the former. According to Marcus, it is related to scarlet fever much the way pseudo-smallpox is to genuine smallpox. My observations lead me to concur with those to whom Rötheln seems to be a variation of scarlet fever, with which according to the observations of physicians such as Formey, Heim, Hufeland it concurs in being generally accompanied by an inflammation of the throat, erupting as early as the second day after the commencement of the fever, behaving under finger pressure as do the blotches of scarlet fever, and ending with the loss of large pieces of epidermis, and also insofar as (according to Heim) one discerns the specific, repugnant smell of the sort that accompanies scarlet fever.

§ 675.

According to Heim, Rötheln consist either in red blotches that, though not unlike those accompanying measles, are of a brighter color, somewhat larger (1 to 1½ lines in diameter), irregularly formed and sharply delineated, or in red, less sharply delineated blotches about the size of an average grain of millet that from the dark, red center point outward become paler, and which in light cases of the illness can appear in individual areas and isolated, in severe cases, however, are quite numerous, large (up to two lines), and then, since the skin between them becomes completely red, on the second and subsequent days exhibit the appearance of genuine scarlet-fever blotches.

After the initial fever, accompanied by an inflammation of the throat and coughing but without the usual catarrhal symptoms and especially without catarrhal inflammation of the eyes, the blotches suddenly break out all over the entire body, are even and smooth, often mixed with heat rash, become paler after three to four days, disappear after six or at most ten days without leaving behind red blotches, the illness then ending with the loss of epidermis in large swatches.

§ 676.

The course, stages, and duration concur almost completely with those of scarlet fever, though in the case of Rötheln the inflammation of the throat generally continues even after the appearance of the eruptive blotches, indeed, can become even more vehement; the fever usually exhibits a lighter inflammatory character, the eruptive blotches do not quickly dissipate; severe brain damage is rare, and the entire illness usually mild and benign.

§ 677.

The inclination to contract Rötheln is primarily present in children. This illness is caused by contagion and, since it is usually observed before and after epidemics of scarlet fever, probably also, like scarlet fever itself, caused by a specific disposition of air and weather conditions.

§ 678.

Treatment is quite the same as that indicated above in the case of scarlet fever [§§ 666–673]. In most cases, one merely needs a method of healing that gently promotes perspiration and transpiration throughout the entire course of the illness.

It may be worth pointing out that Rötheln did indeed affect adults. Susette Gontard (1769–1802), the great love of Hölderlin, who transfigured her poetically as Diotima, is said to have died of Rötheln and consumption. Hölderlin’s friend Isaac von Sinclair (1775–1815) breaks the news to him on 30 June 1802 (Friedrich Hölderlin, Sämtliche Werke, Grosse Stuttgarter Ausgabe, 7 vols., ed. Friedrich Beissner, vol. 7.1: Briefe an Hölderlin; Dokumente 1770–1795, ed. Adolf Beck [Stuttgart 1978], 170):

On the 22th of this month, Madam Gontard died, of Rötheln, on the 10th day of her illness. Her children were with her and survived her. She suffered from a dangerous cough this past winter that weakened her lungs. She remained the same up to the end. Her death was like her life.

It profoundly moved me, and I weep as I write this. I no longer saw her after your separation, and I considered it unworthy to inquire about a being that was living the immutable life of the deity. So the news was all the more unexpected, though I also received it with a heart all the more pure, and I speak with you now not unworthy of her.

Translation © 2018 Doug Stott