In the FIRST VARIETY, the acrid effusion is poured forth between the skin and the subjacent muscles, to which, however, it is limited. Whitlow. In the SECOND, it insinuates itself between the tendons and the periosteum. And in the THIRD, between the periosteum and the bone, which is often, hereby, rendered carious. It is to this last, or malignant whitlow, that Felon, the term felon is most correctly applied. Similar inflammations are occasionally to be found in the soles of the feet, and palms of the hands; they break through the skin or cuticle with difficulty from their thickness; and hence become diffused, and, in the latter case, separate the cuticle from the skin beneath. what. Found cecasionally in other parts. Acute pain, how pro duced. In the whitlow, the acute and lancinating pain complained of arises partly from the thickness and inelasticity of the skin about the finger-nail, but more from the hardness of the finger-nail itself; both which act like a tight bandage upon the inflamed part, and do not allow it to swell or give way to the extravasation. In Cataplasms peculiarly these cases, therefore, we can easily see why the applica- useful. tion of poultices should be of more service than in any other; for they can here act mechanically; or, in other words, their moisture becomes imbibed by the cuticle, as by a sponge, so that it softens, grows larger in its dimensions, and less rigid in its texture: while the nail itself loses a part of its hardness, and becomes suppler. It is in consequence of the peculiar firmness of the skin Soft parts around the nail that the soft parts below are so often pushing seen pushing out through a very small opening in the through the skin as soon as this has been effected, and appearing like opening. a fungus; but so exquisitely irritable as to give a more impressive idea of soreness, than, perhaps, any other kind of ulceration whatever. All this proceeds from the surrounding belts of the cuticle not giving way to the below, why GEN, V. ronychia. Whitlow. increase of the parts underneath; whence they are Phlysis Pa- squeezed out of this small opening like paint out of a bladder. It is a common practice to eat away this protruded part by escharotics, as if it were a diseased fungus; but this is to give additional pain without any benefit, for the be removed pressure from below will not be hereby diminished. By continuing the poultice, the tumefaction will subside, and consequently the pressure cease. part not to by escharo tics. Treatment. Produced by most causes of inflamma tion. causes. In the first stage of the complaint leeches should be applied, and if the inflammation be hereby diminished, it may sometimes be carried off by astringent lotions, or ardent spirits, which excite the surrounding absorbents to additional action. Most of the causes of inflammation operate in the production of this peculiar affection. It is also occasioned by an incurvation of the nail *; posBy peculiar sibly sometimes by a caries or morbid state of the subjacent bone in the tendinous and periosteous variety, as asserted by Siebold +; and Mr. John Pearson has shown that it may occasionally result from a syphilitic diathesis, or any other depraved habit ‡. It seems, moreover, in some cases, to be produced by the bite, or burrowing of the larves of one or more minute, and, to the naked eye, invisible insects, hatched on the leaves of various field plants, and especially fescue-grass: and is said to be also occasioned by the bite of the gordius aquaticus, or hair-worm. Vicat. Delect. Observ. Pract. † Chirurgisches, Tachebuch. XI. GENUS VI. ERYTHEMA. Inflammatory Blush. RED, GLABROUS, TUMID FULNESS OF THE INTEGU- THIS genus of inflammation is entitled to a minute and discriminative attention, not only on account of its violence and tendency to an almost unlimited spread, but from its having been very generally confounded with an exanthem or eruptive fever which, in one or two of its species, it frequently accompanies, but of which it is then a mere symptom. GEN. VI. serving of Why declose at tention. Generic term em ployed by crates; for which erysipelas Erythema, from peulos, "rubor" is a term of Hippocrates, who uses it as nearly as may be in the sense now offered; and for which many modern writers of our Hippoown country have not unaptly employed the vernacular term INFLAMMATORY BLUSH; since the redness has often very much the appearance of a blush, or glowing suffusion of the cutaneous capillaries. For ERYTHEMA Celsus and Galen have unfortunately adopted the term erysipelas, whence Duretus, in his Latin version of Hippocrates, has used suffusio erysipelatosa. And hence erysipelas has been made a very common synonym of erythema by general writers, while the nosologists, with a few exceptions, have limited erysipelas to that species of exanthem or eruptive fever which is vernacularly known by the name of St. Anthony's Fire; and have revived erythema to express the local affection, or restored has been used by Galen; Celsus and though plied to an eruptive since ap fever by many noso logists: who have GEN. VI. Erythema. Inflamma tory blush. erythema to its original import: whence peculiar inflammation before us, in which the pyrexy is. mostly symptomatic. Frequently, however, as these two disorders have been confounded, from an indiscriminate application of the same name to both, it will not be difficult to draw a distinctive line between them. Erythema bears the same analogy to phlegmon, as erysipelas does to small-pox. Phlegmon is local inflammation tending to suppuration; confounded. erythema, local inflammation tending to vesication: Distinctive small-pox is an idiopathic fever producing a phlegmocharacters. nous efflorescence; erysipelas, an idiopathic fever pro the two disorders have been Erythema sometimes used in a second sense, equally loose and indeterminable. ducing erythematic efflorescence. Small-pox is always contagious; erysipelas occasionally so; phlegmon and erythema have no such tendency. The distinction then between erysipelas and erythema is clear; yet the confusion, just noticed, has been increased by some writers who have not only used erysipelas in its popular yet erroneous signification of erythema, but have also employed erythema in a new and unjustifiable sense; as occurs particularly in Dr. Willan's classification of Cutaneous Diseases: where, while erysipelas is made to embrace both erysipelas and erythema, as these terms have hitherto been commonly used, erythema is arbitrarily appopriated as the name of another collection of cutaneous erubescences of very different characters, and produced by very different causes; some of them primary, others symptomatic affections ; some constitutional, and others local; occasonally smooth, papulous, tubercular, or nodose; most of which should be distributed under different divisions. Thus introduced and explained, erythema, as a genus, will be found to comprise the seven following species, the first three of which are taken with little alteration from Mr. Hunter: 1. ERYTHEMA CEDEMATOSUM. EDEMATOUS ERYTHEMA. Proximate cause local. of Galen. Most of these depend upon a peculiar irritability of the constitution, or of the part in which the inflam- mostly a mation or erythema appears; and the common, though, peculiar irritability perhaps, not the sole cause of such irritability is debility general or or relaxation. Galen, who justly distinguishes between suppurative, Distinctions or, as he calls it, phlegmonous inflammation, erythematic (with him erysipelatous), and edematous, ascribes the first, according to the old doctrine of temperaments, to a prevalence of the sanguineous diathesis; the second to that of the bilious; and the third to that of the phlegmatic or pituitous *. That there is generally a peculiar habit in the last two, and often, as we have already observed, in the first, is so clear as to be indisputable: but it is by no means equally clear that such peculiarity of How far applicable habit is dependent upon the immediate cause Galen has to the preadverted to. The temperaments of the Greek physicians, excepting when in excess, are not inconsistent with the condition of health; and hence, therefore, in connexion with the temperament there is usually, in the last two inflammations, a habit of debility or relaxation. And where this exists, the very same stimulus that in a perfectly healthy frame would produce a common adhesive or suppurative inflammation, under this state of the ulcerative system changes the character of the inflammatory action, rather than and urges on the ulcerative process from the first. It nous. usually commences with peculiar violence, and is peculiarly apt to spread; the surrounding parts being easily excited to act or sympathize in an action to which they are prone. Hence, continued sympathy is a common Continued though not an universal effect, for we sometimes meet with very considerable inflammations confined to the part * De Tumoribus, Præternat. Tom. II. xx. sent genus. Erythema tic inflammation why phlegmo sympathy a common effect, and why. |