PATH 
and chiefly feated in the cartilages and ligaments of the 
affedfed joint; found principally in plethoric habits. 
/ 3 . Strumatofus, fcrofulous white fwelling : pain cir- 
cumfcribed and (hooting from a point; fwelling from a 
general thickening of the part; at firft inconftderable ; 
originating and chiefly feated in the bone. Found prin¬ 
cipally in fcrofulous habits. 
Tliefe varieties are upon the authority of Bell on 
Ulcers ; but Hunter fays, “ I conceive all fuch collec¬ 
tions of matter to be of a fcrofulous nature : they are 
moll common in the young fubjedt, and feldom found 
in the full-grown or old. The fuppuration is not proper 
pus, nor the fwelling proper inflammation.” Hunter on 
Blood, p. 391. See the article Surgery. 
Order III. Exanthematica, [from e fanOsw, to fpring 
forth, to bud.] Eruptive Fevers ; or, cutaneous erup¬ 
tions effentially accompanied with fever. This order 
contains four genera. 
Genus I. Enanthe/ls, [from m, within, and cti 9 ea, to 
fpring, or flower.] Ralh, or efflorefcence from internal 
affection. Generic characters—Eruption of red, level, 
or nearly level, patches; varioufly figured; irregularly 
dift'ufed; often confluent; terminating in cuticular ex¬ 
foliations. There are three fpecies. 
1. Enanthefis rofalia, (Scarlatina of various authors.) 
Scarlet fever: rafh a fcarlet flufh, appearing about the 
fecond day on the face, neck, or fauces; progreflively 
i'preading over the body ; and terminating about the 
feventh day; fever a typhus. Of this genus there are two 
varieties. 
a.. R. fimplex : fever moderate, and terminating with 
the ralh; little proftration of ftrength; (lightly conta¬ 
gious. 
As no authors have written on cutaneous difeafes fo 
ably and fo fully as Drs. Willan and Bateman, we (hall 
extrafl all our accounts of cutaneous difeafes from the 
works of the latter. 
The Rofalia fimplex confifts merely of the ralh, with a 
moderate degree of fever. The day after the flight fe¬ 
brile fymptoms have appeared, the efflorefcence begins 
to (how itfelf, about the neck and face, in innumerable 
red points, which, within the fpace of twenty-four hours, 
are feen ever the whole furface of the body. Thefe, as 
they multiply, coalefce into ftnall patches, but on the 
following day (the third) form a diffufe and continuous 
efflorefcence over the limbs, efpecially round the fingers. 
On the trunk, however, the rafh is feldom univerfal, but 
is diftributed in diffufe irregular patches, the fcarlet hue 
being moll vivid about the flexures of the joints and the 
loins. On the breaft and extremities, in confequence of 
the great determination of blood to the miliary glands 
and papillae of the ikin, the furface is fomewhat rough, 
like the cutis anferina, and feveral papulae are fcattered on 
thefe parts. See Plate III. fig. 2. On the following (the 
fourth) day the eruption remains at its acme; and on 
the fifth it begins to decline, difappearing by interftices, 
and leaving the fmall patches as at firft. At this period, 
and on the evening of the fecond day, fome attention is 
requifite to diftinguilh the fcarlet ralh from mealies: the 
oblervation of the crefcent-like form of the patches of 
the latter, and the more diffufe and irregular fhape of the 
former, will be a material guide. (Compare Plate III. 
fig. 1, with Plate IV.) On the fixth day it is indiftinCl, 
and is wholly gone before the end of the feventh. On 
the eighth and ninth days a fcurfy defquamation of the 
cuticle takes place. The efflorefcence fpreads over the 
furface of the mouth and fauces, and even into the nof- 
trils, and is occafionally vifible over the tunica albuginea 
of the eye : the papillae of the tongue too, which are 
conflderably elongated, extend their fcarlet points 
through the white fur which covers it. The face is of¬ 
ten conflderably fwelled. There is ufually great reft- 
leffnefs, and fometimes flight delirium, which appears to 
be much connected with the great heat of the furface, 
OLOGY. 273 
and continues in various degrees of feverity, together 
with the fever, from three to feven days. A few pa¬ 
tients efcape without any fever, almoft without indif- 
pofition. 
13 . R. parifthmitica, (Scarlatina cynanchica, Cullen; 
S. anginofa, Bateman.) In this variety, the precurfory 
febrile fymptoms are more violent, and an inflammation 
of the fauces appears, together with the cutaneous ef¬ 
florefcence, and goes through its progrefs of increafe and 
decline with it. Occafionally, however, the affedtion of 
the throat commences with the fever, and fometimes not 
until the eruption is at its height. With the firft febrile 
fymptoms, a fenfation of lliffnefs and a dull pain on 
moving are felt in the mufcles of the neck ; and on the 
fecond day the throat is rough and ftraitened, the voice 
thick, and deglutition painful. On this and the two fol¬ 
lowing days, the fymptoms of fever are often fevere ; the 
breathing is oppreffed; the heat of the lkin is more in- 
tenfe than in any other fever of this climate, rifing to 
106 0 , 108 0 , or even nz°, of Fahrenheit’s thermometer. 
There is ficknefs, with headach, great reftleffnefs, and 
delirium ; and the pulfe is frequent, but feeble : there is 
alfo an extreme languor and faintnefs. The tongue, as 
well as the whole interior of the mouth and fauces, is of 
a high red colour, efpecially at the fides and extremity, 
and the papillae protrude their elongated and inflamed 
points over its whole furface. The ralh does not always 
appear on the fecond day, as in R. fimplex, but not un- 
frequently on the third ; nor does it fo conftantly extend 
over the whole furface, but comes out in fcattered 
patches, which feldom fail to appear about the elbow's. 
See the Plate, fig. 3. Sometimes too it vanilhes the day 
after its appearance, and re-appears partially at uncer¬ 
tain times, but without any correfponding changes in 
the general diforder: the whole duration of the com¬ 
plaint is thus lengthened, and the defquamation is lefs 
regular. When the ralh is flight, indeed, or fpeedily dif- 
appears, no defquamation often enfues; while, in other 
inftances, exfoliations continue to feparate to the end of 
the third week, or even later, and large pieces of the 
entire cuticle fall off, efpecially from the hands and feet. 
The tumour and inflammation of the throat often difap- 
pear, with the declining efflorefcence of the lkin, on the 
fifth and fixth day of the fever, without having exhibited 
any tendency to ulceration. Slight fuperficial ulcera¬ 
tions, how'ever, not unfrequently form on the tonfils, 
velum pendulum, or at the back of the pharynx, fome¬ 
times early and fometimes later. Little whitifh (loughs 
are feen, intermixed with the mottled rednefs ; and, when 
they are numerous, the throat is much clogged up with 
a tough vifcid phlegm, which is fecreted among them. 
When thefe are removed, after the decline of the fever, 
fome excoriations remain, which foon heal. 
R. parifthmitica fometimes puts on, towards its termi¬ 
nation, much more formidable charadlers. From its 
commencement fome difference is indeed obfervable, 
though not dillindlly. The efflorefcence is ufually faint, 
excepting in a few irregular patches, and the whole of it 
foon affumes a dark or livid red colour. It appears late, 
and is very uncertain in its duration; in fome inftances, 
it fuddenly difappears a few hours after it is feen, and 
comes out again at the end of a week, continuing two 
or three days. The lkin is of a lefs fteady and intenfe 
heat: the pulfe is fmall, feeble, and irregular : the func¬ 
tions of the fenforium are much difordered; fometimes 
there is early delirium, and fometimes coma, alternating 
with fretfulnefs and violence. The eyes are dull and 
fuffufed with rednefs, the cheeks exhibit a dark-red 
flulh, and the mouth is incrufted with a black or brown 
fur. The ulcers in the throat are covered with dark 
floughs, and furrounded by a livid bafe; and a large 
quantity of vifcid phlegm clogs up the fauces, impeding 
the refpiration, and occafioning a rattling noife, as well 
as increafing the difficulty and pain of deglutition. An 
acrid difcharge alfo diftiis from the noftrils, producing 
fo renefs. 
