VARI. 



the more violent cafes, are intermixed alfo with the marks 

 or veftiges of thofe which have fubfided. 



In different cafes, the progrefs and appearance of the erup- 

 tion vary conliderably, which has given rife to the fubdivifion 

 into fpecies fuggefted by Dr. Willan. Thus in the ^icnejimplex, 

 the eruption confifts of fmall vari, which appear fingly, and 

 are not very numerous, nor accompanied by much inflamma- 

 tion, nor by any intermediate afFedlion of the fliin. Many of 

 the tubercles do not proceed to fuppuration ; but gradually 

 rife, become moderately inflamed, and again llowly fubfide, in 

 the courfe of eight or ten days, leaving a tranfient purplilh- 

 red mark behind. But others go on to a partial fuppura- 

 tion, the whole procefs of which occupies from a fortfiight 

 to three weeks. The tubercles are firfl; felt in the flcin like 

 a fmall hard feed, about the fize of a pin's head, and enlarge 

 for three or four days, when they begin to inflame : about 

 the fixth or feventh day they attain their greateft magnitude, 

 are prominent, red, fmooth, and fhining, and hard and pain- 

 ful to the touch. After two or three days more, a fmall 

 fpeck of yellow matter appears on the apiees of fome of the 

 tubercles ; and when thefe afterwards break, a thinner 

 humour is fecreted, which foon dries into a yellowifli fcab. 

 The inflammation now gradually declines, the fize and hard- 

 nefs of the tubercles diminifli, and the fmall fcab becomes 

 loofened at the edges, and at length falls off at about the end 

 of the third week. The individual tubercles, which rife and 

 fuppurate in fuccelfion, pafs through a fimilar courfe. 



In the acne indurata, the tubercles are larger, as well as 

 more indurated and permanent, than in the former variety. 

 They rife often in confiderable numbers, of a conical, or 

 oblong conoidal form, and are occafionally fomewhat acumi- 

 nated, as if tending to immediate fuppuration, being at the 

 fame time of a bright rofeate hue ; yet many of them con- 

 tinue in a hard and elevated fl:ate for a great length of time, 

 without any difpofition to fuppurate. Others, however, 

 pafs on very (lowly to fuppuration, the matter not being 

 completely formed in them for feveral weeks, and then only 

 a fmall part of the tubercles are removed by that procefs. 

 Sometimes two or three coalefce, forming a large irregular 

 tubercle, which occafionally fuppurates at the feparate 

 apices, and fom.etimes only at the largeft. In whatever mode 

 they proceed, the vivid hue of the tubercles gradually be- 

 comes more purple or even livid, efpecially in thofe which 

 fhew no tendency to fuppurate. Shght crufts form upon 

 the fuppurating tubercles, which after fome time fall off^, 

 leaving fmall fears, furrounded by hard tumours of the fame 

 dark red colour ; and thefe fometimes fuppurate again at 

 uncertain periods, and fometimes flowly fubfide and difappear, 

 leaving a purple or livid difcoloration, and occafionally a 

 flight depreflion, which is long in wearing off. 



The tubercles, even when they do not fuppurate, but efpe- 

 cially while they continue highly red, are always fore and 

 tender to the touch ; fo that wafhing, fliaving, the friftion 

 of the clothes, &c. are fomewhat painful. In its moft fe- 

 rere form, this eruption nearly covers the face, breaft, flioul- 

 ders, and top of the back, but does not defcend lower than 

 an ordinary tippet in drefs-: yet this hmitation of the dif- 

 order is independent of the expofure of thofe parts ; for it 

 occurs equally in men and women. In a few inftances in 

 young men, an extenfive eruption of acne indurata has been 

 feen affefting thefe covered parts, while the face remained 

 nearly free from it. By the fucceflive rife and progrefs of 

 the tumours, the whole furface, within the limits juft men- 

 tioned, was fpotted with the red and livid tubercles, inter- 

 mixed with the purple difcolorations and depreflions left by 

 thofe which had fubfided, and variegated with yellow fup- 



VoL. XXXVI. 



purating points and fmall crufts, fo that very little of the 

 natural fkin appeared. Sometimes the black punfta of the 

 febaceous dufts were likewife mixed with the vari and their 

 fequelae. 



Cure of Vari — Vari being generally a local difeafe, the 

 acne is to be treated chiefly by external applications. Ex- 

 cept in females, indeed, this variety of the eruption feldom 

 calls for the attention of medical men. The ancients agree 

 in recommending a number of ftimulant applications, with 

 the view of difcufling the " thick humours," which were 

 fuppofed to conftitute the vari. Lotions and liniments, 

 containing vinegar and honey, fometimes combined with an 

 emulfion of bitter almonds, and fometimes with turpentine, 

 refin, myrrh, and other gums, or with alum, foap, and 

 Cimolian earth, or the bruifed roots of the hly, cyclamen, 

 narciffus, &c. were the fubftances which they principally 

 employed. They were doubtlefs coreeft as to the principle, 

 as a gentle ft;iraulus to the llcin is the moft fafe and eifeAual 

 remedy. The apprehenfions, which have been ftrongly ex- 

 prelfed by the humoral pathologifts, of producing internal 

 diforder by the fudden repulfion, as it has been called, of 

 thefe cutaneous eruptions, are not altogether hypothetical. 

 Head-ache, and affeftions of the ilomach and bowels, have 

 fometimes been thus produced, which have ceafed on the 

 reappearance of the eruption ; but, on the whole, as far as 

 our obfervation goes, this alternation of difeafe is lefs fre- 

 quent and obvious in this form of acne, than in the puftular 

 and cruftofe eruptions of the face and head. 



The ftimulant apphcations, which are moft eafily propor- 

 tioned to the irritability of the tubercles, are lotions con- 

 taining alcohol, which may be reduced or ftrengthened, 

 according to circumftances, by the addition of any diftilled 

 water. It is not eafy to defcribe the appearances of the 

 eruption, which indicate any certain degree of ftrength in 

 the lotion ; but a little obfervation will teach this difcrimina- 

 tion. If the tubercles are confiderably inflamed, and a 

 great number of them puftular, a dilute mixture will be re- 

 quiCte ; containing, for example, equal parts of fpiritus 

 tenuior and of rofe or elder-flower water. The effeft of a 

 very acrid lotion, under fuch circumftances, is to multiply 

 the puftules, to render many of them confluent, and to pro- 

 duce the formation of a cruft of fome extent, as well as to 

 excite an inflammatory rednefs in the adjoining fl<in. A 

 flight increafe of the inflammation, indeed, is fometimes oc- 

 cafioned by the firft applications of a weak ftimulus ; but 

 this is of fliort duration, and the fkin foon bears an aug- 

 mentation of the ftimulant ; until at length the pure fpirit 

 is borne with advantage, as the inflammatory difpofition 

 fubfides. Under the latter circumftances, even a confider- 

 able additional ftimulus is often ufeful ; fuch as from half a 

 grain to a grain or more of the muriate of mercury, in each 

 ounce of the fpirit ; or a drachm or more of the liquor po- 

 tafffe, or of the muriatic acid, in fix ounces. Acetous 

 acid, as recommended by the ancients, and the liquor am- 

 monijE acetatis, afford alfo an agreeable ftimulant, in proper 

 proportions. Sulphur yields a fmall portion of its fubftance 

 to boiling water, poured upon it, and allowed to infufe for 

 twelve or fourteen hours ; a quart of water being added to 

 about an ounce of broken fulphur. A lotion of this nature 

 has been found advantageous in flight cafes of acne fimplex, 

 and efpecially in removing the roughnefs and dufl<inefs of 

 the face connefted with it. 



Connefted with the eruption of vari, and often giving 



rife to them, is that appearance of black points in the fkin 



of the face and neck, furrounded by a raifcd border of 



cuticle, to which the appellation of acne funHata was given 



4H by 



