MEDICINE. 



Prarr <-. j<t until just previous to that period, in which it was 

 " ~r~~ first noticed as a distinct afl'ertion from Rubcola; but, 

 u|xm the whole, we do not see sufficient evidence for 

 this opinion. The diagnosis between die two coin- 

 plaints in mild cases, is perhaps not always very t-.i-y, 

 nor is it very ini]>ortant ; but whenever they are either 

 of them severe, no difficulty occurs in the discrimina- 

 tion, and it then becomes a very important practical 

 point, as they are of an opposite tendency, and re- 

 quire very different modes of treatment. 



Trenimtm. The measles, in every part of their course, exhibit 

 an inflammatory aspect, and indicate the antiphlogis- 

 tic regimen. Unless the constitution be predispos- 

 ed to pulmonary affections, the disease be unusually 

 severe, occur in very early infancy, or under some pe- 

 culiarly disadvantageous circumstances, Rubeola is not 

 a very dangerous complaint, but it is one in which it 

 is necessary to act in the earlier stages with prompt- 

 ness and vigour, as if this opportunity be suffered to 

 pass by, our remedies will be far less efficacious, or 

 perhaps altogether inapplicable. The degree to which 

 we are to carry the antiphlogistic system must be de- 

 termined by the circumstances of the individual case, 

 by the character of the prevailing epidemic, the season 

 of the year, and other collateral circumstances. Bleed- 

 ing, either general or local, will be often necessary; 

 purgatives are always proper, and we are carefully to 

 maintain a regulated temperature, avoiding the extremes 

 of heat, but shunning the direct application of cold. 

 Any circumstance which may cause the sudden disap- 

 pearance of the eruption is always to be guarded 

 against, as indicating a dangerous state of inaction in 

 the sanguiferous system ; and, should it occur, it must 

 be removed by the means that were pointed out with 

 respect to Small-pox. The cough is sometimes so 

 troublesome a symptom as to require particular atten- 

 tion ; but, for the most part, whatever relieves the fe- 

 brile state will relieve the affections of the chest. At- 

 tempts have been made to produce the disease by ino- 

 culation, but it does not appear that any great benefit 

 is obtained, or that the disease, when communicated in 

 tin's way, is mitigated in the same manner as it is in 

 Small-pox. 



SECT. XXIII. Erysipelas. 



Urticaria There are two other diseases, that are usually placed 

 Pemphigus, by systematic writers among the exanthemata, al- 

 though it would appear without any sufficient claim to 

 this situation, Urticaria or Nettle-rash, and Pemphigus. 

 They both consist of peculiar eruptions, the former, 

 as its name indicates, very much resembling the sting 

 of a nettle, the latter consisting of large irregular ve- 

 sicles. A degree of fever attends them, but it is uncer- 

 tain what relation the topical bears to the general af- 

 fection ; and as they are diseases not very well charac- 

 terized, and often so slight as not to become subject of 

 medical treatment, we have not much accurate infor- 

 mation respecting them. Urticaria is generally con- 

 ceived to depend upon a peculiar state of the stomach 

 and bowels ; and Pemphigus appears to be symptoma- 

 tic of, or consequent to, a general morbid condition of 

 the system. Their treatment chiefly consists in remov- 

 ing any obvious sources of irritation, and in restoring 

 the healthy state of the digestive organs. 



Eryipel. We have placed Erysipelas as an appendage to the 

 genus Exanthema, because although wanting some of 

 its characteristic circumstances, it seems to be more 

 allied to it than to any other class of diseases. It con- 



sists of a fever, which is succeeded at a certain pe- Tract icr. 

 riod by a cutaneous affection ; the fever is of the in- V T" < ~ ' 

 flammatory type, is attended with a degree of drowsi- 

 ness, or even sometimes with coma and delirium ; the 

 head and face are hot and swelled, and a considerable 

 part of the surface is attacked with an inflammation, 

 which frequently produces large vesications that be- 

 come filled with a serous fluid ; it usually appears on 

 the face or on the extremities. This disease differs 

 materially from the other Exanthemata, in occurring 

 more than once to the same individual ; indeed when 

 a person has been affected by it, he is ever afterwards 

 peculiarly liable to its attacks. -Its exciting cause is 

 obscure ; it attaches itself to particular constitutions, 

 which however it is not easy to characterize, and seems 

 to have some connexion with peculiar states of the at- 

 mosphere, as it is epidemic in certain situations, as in 

 hospitals or other places where numbers of sick are 

 crowded together, and especially patients suffering 

 from wounds or surgical operations. It is doubtful 

 whether it be ever properly contagious ; but, upon the 

 whole, the evidence appears to be in favour of its not 

 being so. It has been thought that, when the disease 

 prevails epidemically, as in hospitals, its symptoms 

 differ from those of the cases that occur sporadically, 

 and that in the former instances it assumes altogether 

 a different type, possessing more of the malignant or 

 typhous character ; we are inclined, however, to doubt 

 this conclusion, and are more disposed to attribute it 

 to the greater violence of the complaint under these 

 circumstances, in consequence of which its primary 

 symptoms are more highly inflammatory, and are there- 

 fore succeeded by a state of greater exhaustion. 



Considerable difference of opinion has arisen re- Treatmenti- 

 specting the treatment of Erysipelas, and especially re- 

 specting the question, whether the antiphlogistic plan is 

 to be employed, and whether external cold is admissible; 

 or whether there is the same danger to be apprehend- 

 ed from repelling the inflammation as in some of the 

 proper Exanthemata ? Perhaps no general answer can 

 be given to this question, which will apply to all cases; 

 in the first stage of the disease, the antiphlogistic treat- 

 ment, both general and local, is the one which usually 

 ought to be pursued, but afterwards a medium course 

 seems to be the best ; external warmth aggravates the 

 fever, while the feelings of the patient, and the weak- 

 ness which supervenes, are adverse to the employment of 

 depletion or of any considerable degree of external 

 cold. General bleeding is often necessary at the com- 

 mencement ; and purgatives, in this, as in all febrile 

 affections, form a very valuable remedy. Although it 

 may appear to be indicated by the symptoms, yet topi- 

 cal bleeding is generally condemned, in consequence of 

 the difficulty which sometimes exists in healing the 

 wounds made by the leeches or the scarificator. Dia- 

 phoretics are commonly prescribed ; but if they are 

 administered so as to become sudorific, they aggravate 

 the irritation of the surface. Small doses of opiates are 

 often rendered necessary by the restlessness and agita- 

 tion which attends the disease ; and it is for the same 

 cause peculiarly important to avoid all sources of irri- 

 tation, or to remove them whenever they are present. 

 When the disease terminates fatally, it appears to be 

 from the inflammatory affection being communicated 

 or transferred to the membranes of the brain; it is 

 therefore of great consequence to prevent all those cir- 

 cumstances which might tend to lay the foundation for 

 such a crisis, and to obviate the first appearance of any 

 symptoms which indicate the impending danger. 



