235 
PATHOLOGY. 
but the funftions of the ftomach and of the fenforium 
commune are not evidently dilturbed by this difeafe. 
The duration of this excoriation and difcharge is un¬ 
certain and irregular: when only a fmall part of the 
body is affefted, it may terminate in ten days; but, when 
the diforderhas been univerfal, the patient feldom com¬ 
pletely recovers in lefs than fix weeks, and is often afflifted 
to the end of eight or ten weeks. By fo fevere an inflam¬ 
mation the whole epidermis is deftroyed in its organiza¬ 
tion ; and, when the difcharge ceafes, it lies loofe, affu- 
raing a pale brown colour, which changes almoft to black 
before it falls off in large flakes. As in other fuperficial 
inflammations, however, the new red cuticle that is left 
is liable to defquamate again, even to the third or fourth 
time, but in fmaller branny fcales, of a white colour; 
and a roughnefs fonietimes remains for a confiderable 
period, like a flight degree of Pforiafis. In fome in- 
flances, not only the cuticle, but the hair and nails, are 
alfo obferved to fall off; and the latter, when renewed, 
are incurvated, thickened, and furrowed. 
In fome cafes this difeafe is limited to a fmall fpace; 
and then the difcharge is flight, and its whole duration 
ffiort. Similar local attacks of it occur in irritable con- 
ftitutions, efpecially in hot weather, affe6ting the hands 
and wrifts, the neck and external ear, and other parts, 
but without any conftitutional diforder. Succeflive crops 
of the veficles arife in irregular patches, with a red blulh 
around them, which produce partial incruftations, as 
the ichor that iffues is dried : and by thefe vefications 
and deficcations of the matter the affection is kept up for 
fome weeks. 
The treatment of this fpecies of Erythema may be 
comprifed in few words; for it is principally palliative. 
But, although medicine may not poflefs the power of 
(hortening the period of its duration; yet the omiflion 
of the palliative meafures will allow an extreme aggrava¬ 
tion of the fufferings of the patient to take place, and 
probably prolong it beyond its natural courfe, as well as 
contribute to wear out the vigour of his conftitution. 
The mifery and exhauftion, refulting from the excellively 
tender and irritated ftate of the {kin, may be greatly al¬ 
leviated by frequent ablution or fomentation with warm 
gruel, or (trained bran and water; or by the frequent 
ufe of the warm bath, which has the advantage of clean¬ 
ing the furface without occafioning any abrafion by 
friction. A conftant application of poultices has pro¬ 
duced confiderable eafe to the patient, when the affection 
was confined to the extremities. Where the cuticle has 
exfoliated, Mr. Pearfon recommends the application of 
a tnild cerate, confiding of litharge plafter, wax, and oil, 
fpread thickly on linen rollers, and renewed twice a-day. 
With the fame view of diminifliing the irritation of the 
furface, the bed and body linen of the patient, which 
becomes hard and ftiff as the difcharge dries upon it, 
(hould be frequently changed. Every additional irrita¬ 
tion from flimulating food and drink (hould be avoided ; 
the bowels (hould be kept open by the adminiftration of 
occafional laxatives; and opiates may be given for the 
purpofe of foothing the fenfations of the patient. The 
fulphuric acid is grateful and refrefiiing ; and, in the de¬ 
cline of the fwelling and difcharge, it may be combined 
advantageoufly with the exhibition of farfaparilla. 
5. Erythema pernio, chilblain: colour crimfon fuf- 
fuied with blue; obftinately itching; chiefly affefting 
the extremities during winter. Two varieties. 
a. Simplex: the cuticle remaining unbroken. 
6. Exulceratus; accompanied with ulceration. 
Intenfe cold produces the fame efteft, in exciting in¬ 
flammation, as intenfe heat. Hence chilblains are bed 
treated on the fame principles as burns or fcalds. In the 
firft variety, cold fpirituous applications are to be ufed; 
and the patient (hould avoid the extremes and alterna¬ 
tions of heat and cold ; confequently Ihould not put his 
feet near the fire on coming out of the cold. The fecond 
variety is to be treated by poultices. Terrible examples 
Vol. XIX. No. 1300. 
of this chilblain occurred among the French foldiers on 
their retreat from Mofcow. On this occafion Baron 
Larrey, in his circular to the French furgeons, fpeaking 
of the effefts of intenfe cold, obferves, that, in general, 
froft-bitten fores (plaies de congelation) prefent the 
fame phenomena as burns. In both cafes a gangrenous 
efchar, more or lefs extenfive, is formed, the feparation 
of which mult be promoted by topical applications which 
excite the furrounding found parts. The molt fimple 
and effectual drefling was unguentum de fiyrace, fpread 
on linen or lint. Alcoholic embrocations and decoc¬ 
tions of cinchona counterafted the procefs employed by 
nature in the cure. The efchars feparated, the wounds 
are to be confidered as fimple, and treated accordingly. 
When chilblains fphacelate, they are to be treated as 
gangrene in general. 
6. Erythema intertrigo, erofion of the (kin : colour 
bright red ; cuticle eroded; the expofed cutis oozing a 
limpid and acrimonious fluid. This arifesfrom peculiar 
acrimony in the matter of perfpiration, or acrid fub- 
ftances intermixing with its natural fecretion ; it occurs 
moftly in children, in the folds or duplications of the 
(kin, as the groins, armpits, and behind the ears. Tepid 
ablution, and certain abforbent powders well known to 
mothers and nurfes, e. g. fuller’s earth, comprehend all 
that is required for the cure of this erofion. The bowels 
(hould be opened if coltivenefs is prefent. 
Genus VII. Emprefma, [from I flame or burn 
within.] Internal Inflammations. Generic characters— 
Deranged function of a vilceral organ, membraneous or 
parenchymatous, with local pain; fever moftly a cauma; 
inflammation moftly adhefive. 
Hitherto we have fpoken only of thofe inflammations 
which, obvious to the fight and touch, cannot be milla- 
ken for complaints of a different kind. But the genus 
upon which we are now entering prefents a vaft number 
of the mod ferious difeafes which we are afflifted with ; 
and which are difficult torecognife, not only from their 
hidden fituation, not only from the fimilarity which the 
fymptoms of each fpecies hold to thofe of another, and 
from the occafional refemblance which they all bear to 
irritative or fympathetic diforders. It is in every cafe a 
matter of great moment to diftinguifh whether a difeafe 
be inflammatory or otherwife ; fince, this grand diftinc- 
tion once eftablifhed, we know whether it is abfolutely 
neceffary to aft decifively and at once, or whether we may 
be allow’ed to wait and watch the full development of 
the difeafe. We may reft more fully contented when we 
have made this diftinftion, becaufe the firft treatment of 
all internal inflammation is nearly fimilar. So ftrongly 
was this truth impreffed on the mind of the accurate 
Celfus, that, before he difcriminates any difeafes by name, 
he marks certain fymptoms orfigns which require or au¬ 
thorize blood-letting, purging, and fimilar aftive mea¬ 
fures. In urging the importance of this general diftinc- 
tion, we are by no means unconfcious how neceffary it 
often is to diftinguifh at an early period the precife fitua¬ 
tion of Phlogofis; and in many inftances it is prafticable 
to do fo. But that it is not fo in all is one of the moll 
firmly eftablifhed fafts in medical fcience. Cafes have 
occurred even in the brain, an organ above all others dif- 
pofed to take on inflammation from irritation, which fo 
clofely imitated Phrenitis, that the molt accurate prafti- 
tioners have been deceived by it; yet, on difleftion, no 
inflammatory aftion has been difcovered. This circum- 
ftance is the more lamentable, becaufe irritation and in¬ 
flammatory difeafe require to be differently treated. It 
may be borne in mind, however, that the wrong treat¬ 
ment of irritation is feldom fo fatal as the wrong treat¬ 
ment of inflammation. 
The marks whichdiftinguifti inflammation from violent 
fpafm are too obvious to be miftaken by the mod fuper- 
ficial obferver. In the prefent inftance, therefore, we 
(hall confine our diagnofis to thofe infidious approaches 
3 P of 
