trary, ulcerates briskly, and hence should be allowed to burst or at least should not be opened early. GEN. VI. SPEC. II. Erythema sum. tous ery thema. At the commencement of this inflammation there is erysipelatocommonly some degree of fever, accompanied with pro- Erysipelastration of strength and dejection of spirits, and especially with loss of appetite. But the fever soon subsides, while the inflammation pursues its course; yet since one source of irritation has thus departed, it is less violent, fever at and sometimes assumes a chronic character. Some de gree of first; which soon while the in Treatment. Tonics. As this, like the last, is a disease of weakness, the subsides, same general tonic plan will be calculated to oppose it; flammation and where there is a tendency in the separated skin to continues. crack, absorbent earths or powders should be scattered freely over the ulcerative or oozing parts, to imbibe the Absorbent acrid fluid as it escapes, or the ulceration will soon be- earths apcome extensive; and the feeble and inflamed subjacent plied locally. skin, hereby exposed to the stimulus of external agency, will grow gangrenous with great speed. Finely pounded Starch. starch is a useful powder for this purpose; as it combines a tonic and an astringent with an absorbent power; so, likewise, is a mixture of equal parts of starch and finely levigated calamine or rhubarb. The last I have Calamine. sometimes thought peculiarly effectual in checking the Rhubarb. irritation; as the second appears to be in preventing the further spread of the inflamed outline that surrounds the separated cuticle. attacks in mixt form, This species of inflammation sometimes attacks infants Sometimes from a very early period after birth; and, what is more fants; singular, they have in a few instances been born with it. In such cases it appears to be produced by some occasional cause, co-operating with an erythematic diathesis derived hereditarily. It generally assumes the mixt chiefly in a form of phlegmonous erythema; suppurates imperfectly as it takes its course through the cellular membrane, and is often succeeded by gangrene. Its progress is very rapid from the relaxed state of the infantile fibre: and from the extrication of air, as soon as gangrene is pro- and spreadduced, the tumified surface has the mixt feel already abdominal noticed of fluctuation and crepitation. It commences viscera. proceeding with great rapidity, ing to the sum. Erysipelatous erythema. GEN. VI. usually about the genitals, works its way below towards SPEC. II. the thighs and legs, and above towards the abdomen, Erythema erysipelato- and often excites on the peritoneum the same caseous or purulent secretion which is so apt to form on this membrane in puerperal fever. As there is no disposition to adhesion, the fluid spreads in every direction, wherever the ulceration makes a way for it; and hence it has often descended in great abundance into the tunica vaginalis and labia pudendi. Purulent secretion very copi ous. Treatment. Stimulant epithems of ether, alcohol, and camphorated spirits, applied in the first stage of the disease to the parts affected, have been found the most beneficial practice they act as counter-irritants, and take off the morbid excitement by the production of an artificial and more manageable inflammation. To these ought by all means to be added the use of the bark in any way in which it can be introduced, especially in that of injections repeated several times a day. SPEC. III. Where SPECIES III. ERYTHEMA GANGRÆNOSUM. Gangrenous Erythema. THE COLOUR DUSKY-RED; SUPERFICIAL; CUTICLE SEPA- GEN. VI. THE gangrenous erythema, like the two preceding species, is a frequent companion of debilitated or relaxed chiefly to be constitutions, but is mostly to be met with in advanced age, or weakly adolescence, or infancy; and particularly found. GEN. VI. SPEC. III. Erythema where, in old age, the constitution has been broken down by habits of intemperance and excess; the circulation is languid, and the blood even in the arteries assumes a gangrænovenous appearance. The inflammatory stage is in these cases sometimes very slight, and the gangrene is ushered nous inin with very little previous affection. sum. Gangre flammation. Anteceded by little previous in Either of the preceding species will pass readily into the present, in a warm, stagnant, and corrupt air; for the same reason that all hospital wounds run rapidly into the same state under the same circumstances, as we the preshall have to notice hereafter. Local applications are here of far less importance than an attention to the general condition of the constitution. Stimulants and perfect cleanliness are perhaps all that are demanded under the first head; while, under the second, pure air, and a steady course of tonic medicines and diet, adapted to the age and habits of the patient, are absolutely indispensable; and can alone furnish any hope of recovery. How far this disease appertains to the ignis sacer of the Roman writers, will be seen under the ensuing species, which forms another subdivision of the same affection. flammation. A result of ceding species in vitiated air. Curative intention. SPECIES IV. ERYTHEMA VESICULARE. Uesicular Erythema. COLOUR PALE-RED; SURFACE ROUGHISH, AND COVERED A REDDISH FLUID; PROGRESSIVELY TRAILING INTO THE NEIGHBOURING SOUND PARTS. THIS species admits of two varieties, which have been pointed out from the age of Celsus: GEN. VI. SPEC. IV. GEN. VI. SPEC. IV. Erythema vesiculare. Vesicular erythema. a E. vesi culare be nignum. Benign vesicular erythema. B E. vesi culare cor rosivum. Erosive vesicular erythema. General remarks. Ignis sacer synonymous with preceding species. Common erroneous view of a Benignum. B Corrosivum. Benign vesicular Erythema. Erosive vesicular Erythema. In the FIRST, the redness and vesicles advance without a breach of the cuticle, as the part that has passed through the action is healing. In the SECOND, the vesicles break in the part first affected; and the erosive fluid produces tracks of sanious ulceration as the redness advances. Under the present and the preceding species is included the IGNIS SACER of the ancients; about which much has been written, but which has been seldom understood, and never hitherto allotted a clear methodic position. The author has taken some pains upon the subject, and trusts he will be able to establish the true boundary and character of a disease, not more frequently described by the physicians, than celebrated by the poets of antiquity. The common error has consisted in making the ignis this and the sacer, or holy fire, an exanthem or eruptive fever; an erysipelas or a pestis; or some other idiopathic fever of the same order. There is no doubt, indeed, that, like the erysipelatous erythema, it has at times been met with as an accompanying symptom in pestis; and when we shall come to treat of this disease, a distinct notice will be ignis sacer; taken of the variety which such an accompaniment produces, and of which the plague of Athens seems to furnish us with a tolerable example; but the ignis sacer, in its genuine and simple state, instead of being marked with a low eruptive fever, has often very little fever of any kind; certainly nothing more than symptomatic fever; and by Celsus is described as being best cured by an ephemeral or any other fever which may give increased action to the system; hereby proving that this, like the entire group of erythemas, is a result of debility. usually accompanied with but little py rexy. A result of debility. Import of sacer in medicine. In ancient times some diseases were supposed to be inflicted on mankind by the special interposition of the Divinity, or of his ministers: and to these was assigned the name of sacer, or holy; though the peculiar crimes for which they were inflicted, or the names of the particular persons who in this manner first drew down the special SPEC. IV. Erythema Vesicular erythema. vengeance of Heaven upon their atrocities, have not been GEN. VI. communicated to us. The later term of Saint or Sanctus, as in St. Anthony's fire or St. Vitus's dance, are of vesiculare. parallel origin, and express corporeal punishments first inflicted by the agents or supposed agents of the deity Sanctus, whose names they respectively bear. Ignis is a term or Saint. expressive of the heat, redness, acrimony, and erosive power of a disease; and is hence applied to the present in common with many other affections. upon from Cel His first species, sywith ery nonymous thema vesi culare. The best description of the IGNIS SACER that has de- Description scended to us from the Roman writers, is that of Celsus. He represents it as a genus comprising two species, the first of which is precisely parallel with the species before us, and the second with the erythema gangrænosum, or the preceding; and, in order to prevent any doubt this subject, the definitions of both species are here given, as nearly as may be, in the words of Celsus himself. "It has", says he, "two species; one (the vesicular erythema of the present system) is reddish, or a mixture of redness and paleness, rough with approximating vesicles (pustula), none of which are larger than the rest, and which for the most part are very small. In these are almost always found a fluid (pus), and often a red colour with heat." Then follows his description of the two varieties just given, the benign and erosive, in the following words: "sometimes it trails along, the part healing that was first diseased"; corresponding with the variety a of the present system. And "sometimes the part ulcerating; in consequence of which the vesicles (pustula) break, the ulceration keeps spreading, and the fluid escapes"; alike corresponding with the variety B. Celsus then passes on to describe his second species, species sywhich answers to the character and almost to the words with eryof erythema gangrænosum, or that we have just consi- thema gandered. "The other species", says he, "consists in an ulceration of the cuticle, without depth, broad, sublivid, but unequally so; and the middle heals, while the bound * De Medicinnâ. Lib. v. Cap. xxvIII. Sect. 4. His two vathis species. rieties of His second nonymous grænosum. |