CLASS II. 1. 3. OF SENSATION. 189 



When the external skin is the seat of inflammation, and pro- 

 duces sensitive irritated fever, no collection of matter is formed, 

 as when a phlegmon is situated in the cellular membrane beneath 

 the skin; but the cuticle rises as beneath a blister-plaster, and 

 becomes ruptured; and a yellow material oozes out, and be- 

 comes inspissated, and lies upon its surface; as is seen in this 

 kind of erysipelas, and in the confluent small-pox; or if the new 

 vessels are re-absorbed the cuticle peels off in scales. This dif- 

 ference of the termination of erysipelatous and phlegmonic inflam- 

 mation seems to be owing in part to the less distensibility of the 

 cuticle than of the cellular membrane, and in part to the ready 

 exhalation of the thinner parts of the secreted fluids through its 

 pores. 



This erysipelas is generally preceded by a fever for two or 

 three days before the eruption, which is liable to appear in some 

 places as it declines in others; and seems frequently to arise 

 from a previous scratch or injury of the skin; and is attended 

 sometimes with inflammation of the cellular membrane beneath 

 the skin; whence a real phlegmon and collection of matter be- 

 come joined to the erysipelas, and either occasion or increase 

 the irritated fever, which attends it. 



There is a greater sympathy between the external skin and 

 the meninges of the brain, than between the cellular membrane 

 and those meninges; whence erysipelas is more liable to be pre- 

 ceded, or attended, or succeeded, by delirium than internal 

 phlegmons. I except the mumps, or parotitis, described below; 

 which is properly an external gland, as its excretory duct opens 

 into the air. When pain of the head or delirium precedes the 

 cutaneous eruption of the face, there is some reason to believe, 

 that -the primary disease is a torpor of the meninges of the brain; 

 and that the succeeding violent action is transferred to the skin 

 of the face by sensitive association; and that a similar sympathy 

 occurs between some internal membranes and the skin over them, 

 when erysipelas appears on other parts of the body. If this cir- 

 cumstance should be supported by further evidence, this disease 

 should be removed into Class IV. along with the rheumatism 

 and gout. See Class IV, 1. 2. 17. 



This supposed retropulsion of erysipelas on the brain from 

 the frequent appearance of delirium, has prevented the free use 

 of the lancet early in this disease to the destruction of many; 

 as it has prevented the subduing of the general inflammation, 

 and thus has in the end produced the particular one on the 

 brain. Mr. B , a delicate gentleman about sixty, had an ery- 

 sipelas beginning near one ear, and extending by degrees over 

 the whole head, with hard, full, and strong pulse; blood was ta- 



