CLASS III. ORDER III. Ordinary import. THE term Exanthemata among the Greeks, from έavléw, "effloresco 66 per summa erumpo", "to effloresce, or break forth on the surface" imported cutaneous effio- ordinal rescences or eruptions generally. It has since been limited name. to express cutaneous eruptions accompanied with fever, limitation of a boundary assigned to it by Sauvages, Linnéus, Vogel, Sagar, Macbride, Cullen, and various others, and this, in effect, is its general meaning in the present day. Dr. In what Cullen, however, in his note on Exanthemata, thinks it worth considering whether the word should not be restrained to eruptions (he does not say febrile eruptions) produced alone by specific contagion: "eruptiones à contagione specifica ortae"; while Dr. Willan has still more how used by lately narrowed it so as to include those eruptions only which fall within the meaning of the English term RASH, whether febrile or not febrile. sense pro posed by Cullen: Willan. CLASS III. ORDER III. Exanthematica. Eruptive fevers. In the present work its common sense. The two last senses of EXANTHEMATA, OF EXANTHEMATICA, are new and singular. Dr. Cullen, however, has not followed up his own suggestion into his own classification; while Dr. Willan has not always continued strictly true to his own views and definition, as I have observed in the running comment introductory to the present order in the volume of Nosology to which the reader may turn, for a fuller examination of this subject, at his leisure. The term, therefore, in the present work, is employed employed in in its common and current sense, so as to include all cutaneous eruptions in which fever exists as an essential symptom; whether accompanied with or destitute of contagion; which last is a doubtful, and perhaps an inappropriate ordinal character. Doubtful, because we cannot very precisely tell where to draw the line: and inappropriate, because it is a character that applies to discases of very different kinds, and that are scattered over the entire classification, as dysentery and influenza in which there is fever without cutaneous eruption; itch, and many varieties of tetter, in which there is cutaneous eruption without fever, and blennorrhoea or clap, in which there is neither fever nor cutaneous eruption. The genera included in the order are distinguished by the nature of the eruption as consisting of red, level or nearly level patches of pimples filled with a thin ichorous fluid; of pimples filled with a purulent fluid; and of foul imperfectly sloughing tumours; and hence consist of the four following: General character. I. ENANTHESIS. III. EMPYESIS. IV. ANTHRACIA. RASH EXANTHEM. ICHOROUS EXANTHEM. PUSTULOUS EXANTHEM. CARBUNCULAR EXANTHEM. Each of these, with the exception of the third, comprises several species: and all concur in evincing the existence of morbid and specific poisons in the blood, acting the part of animal ferments, converting the different fluids into their own nature, exciting the commotion of fever, and being eliminated on the surface, as the best CLASS III. and most salutary outlet to which they can be carried, by the very fever which they thus excite. ORDER III. Exanthematica. Eruptive fevers. power. The whole is a wonderful circle of morbid and restorative action, evincing the most striking proofs of that in- Evincing stinctive or remedial power of nature whose presence in proofs of instinctive every part of every living frame, whether animal or ve- or remedial getable, is continually discovering itself; and, which, under the general control of an infinite and omniscient Providence, is perpetually endeavouring to perfect, preserve, and repair the individual, and to multiply its species. We have many times had occasion to observe that, Illustrated. wherever any diseased action is taking place internally, there is a constant effort exhibited in the part or in the system generally, to lead it to the surface where it can do least mischief*, rather than let it spread itself on the deep-seated or vital organs, where its effects might be fatal. Mr. John Hunter was peculiarly fond of dwelling on this admirable economy of nature, and of illustrating it from the course pursued in inflammations of every kindt; which, to obtain this beneficial end, often wind their way outwardly through a multiplicity of superincumbent organization, instead of opening into some momentous cavity in the interior, from which it is perhaps only separated by a thin membrane. But there is no part of pathology in which this display of a final cause, of an operative intention admirably adapted to the end, is more striking than in the order of eruptive fevers. It is by means of the fever that the disease works its own cure; for it is hereby that a general determination is made to the surface, and the morbid poison is thrown off from the system. Eruptive fever a na tural mean of curing the eruption. But the fever may be too violent; and, from accidental But if viocircumstances, it may also be of the wrong kind: both * See especially Class II. Ord. II. On Inflammation, Vol. II. p. 291. † On Blood, Inflammation, &c. pp. 236. 450. 467. lent more mischievous than the eruption. CLASS III. which facts occasionally occur in inflammations, and require the art of medicine for their correction. ORDER III. Exanthematica. Eruptive fevers. Hence a small degree necessary. Error of earlier practitioners in fever. When a febrile poison, producing a cutaneous eruption is generated, or has been conveyed into the blood, a small degree of fever is sufficient to throw it upon the skin; and if it exceed the proper extent, the specific virus of fever only will be multiplied, and the fever itself may become a source of real danger. It was formerly the practice to encourage the fever by cardiacs, a heated atmosphere, and a load of bed-clothes, from an idea that we hereby solicit encouraging a larger flow of morbific matter from the interior to the surface. The fact is unquestionable; for be the exanthem what it may, the skin will hence, in almost every instance, be covered with eruption. But it did not occur to the pathologists of those times, that the morbid virus was an animal ferment, capable of multiplying itself by accessories; and that heat and febrile action, beyond a very low medium, are among the most powerful accessoExamples of ries we can communicate. And hence the advantage of the modern practice of applying cold water in scarletfever, and cold air in small-pox, with a view of mitigating the fever that often accompanies these diseases: for, by diminishing the febrile violence, we do not, as was formerly imagined, lock up the contagion in the interior of the system, but prevent it from forming afresh and augmenting there. correction in modern times. Fever may be of the But the fever, though the natural mode of cure, may wrong kind, not only be too violent, but it may be also of the wrong as well as in kind. And here, again, the whole scope of professional skill is often demanded. excess. Different contagions are accom panied with different fevers. Some of the morbid poisons we are now adverting to have a natural tendency to excite a fever of one description, and others of another. Thus the fever of smallpox and measles is ordinarily inflammatory; that of scarlet fever may commence with an inflammatory type, but it has a strong tendency to run into a typhous form : while that of pemphigus and plague is typhous from the beginning. |