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May 3, 1902


JAMA. 1902;XXXVIII(18):1165. doi:10.1001/jama.1902.02480180043009

It is almost two years since Clement Dukes called attention to what he designated1 the "fourth disease." He believes this disease to be distinct from scarlatina, measles and rubella. Since the publication of Dukes' paper, the subject has been much discussed among British clinicians and the writers have been divided into two sets, one denying the existence of the "fourth disease" as an entity and recognizing the cases so described as only erratic instances of the well-known dieases, especially of scarlatina and rubella, while the followers of Dukes are equally convinced that the disease is a distinct and separate one. It is probably impossible to come to a conclusion of the controversy at present. The clinical course of the various eruptive diseases is so variable that different phases or forms of one disease might be looked upon as separate diseases, and every practitioner knows how difficult it is to