275 
PATHOLOGY, 
fable points and fpecks under the cuticle, intermixed with 
minute papulae, in fome cafes forming irregular patches, 
in others coalefcing into an uniform flulh over a confi- 
derable extent of furface. In the Meafles the rafli is 
compofed of circular dots, partly diftindf, partly fet in 
fmall clufters or patches, and a little elevated, fo as to 
give the fenfation of roughnefs when a finger is paifed 
over them. Thefe patches are feldom confluent, but 
form a number of crefcents or fegments of circles, with 
large intervening portions of cuticle, which retain their 
ufual appearance. In Scarlatina, when any part of the 
rafli has a tendency to circular forms, the circles are 
ufually completed; fometimes their circumferences inter- 
feft each other varioufly. The colour of the rafli is alfo 
different in the two difeafes, being a vivid red in Scarla¬ 
tina, like that of a boiled lobfter’s fhell; but in the 
Meafles a dark red, with nearly the hue of a rafpberry. 
3. During the febrile ftage, the Meafles are diftinguifhed 
by an obftinate hoarfe cough, forcing up, in repeated 
paroxyfms, a tough acrimonious phlegm; by an inflam¬ 
mation of the eyes and eye-lids; by an increafed dif- 
charge from the lachrymal gland, fneezing, &c. The 
Scarlatina is frequently attended with a cough, alfo with 
rednefs of the eyes from an extenfion of the rafli to the 
tunica albuginea, circumftances which render the diftinc- 
tion between this complaint and Meafles particularly dif¬ 
ficult, if other fymptoms be not clear and deciflve. On 
minute obfervation, however, it will be generally, per¬ 
haps always, found, that the cough in Scarlatina is fliort 
and irritating, without expectoration ; that the rednefs 
of the eye is not attended with intolerance of light; that 
the ciliary glands are not affeCted ; and that, although the 
eyes appear fhiningand watery, they never overflow. 4. 
Mod writers, in diftinguifliing Scarlatina from Meafles, 
obferve that there is a peculiar fenfation of anxiety, de- 
prefiion, and faintnefs, in all cafes of it which are atten¬ 
ded with fever. 5. When the rafli appears on the third 
or fourth day, being fcattered, and of a dark fliade of 
colour, as frequently happens in the two laft varieties of 
Scarlatina, the difeafe may be diftinguiflied from Meafles, 
by the appearances in the throat, by the rigidity of the 
mufcles of the neck, &c.” 
In the treatment of themildeft cafes of Rubeola, as lit¬ 
tle medical practice is neceflary as in the milder cafes of 
Rofalia; and, in cafes of more feverity, bleeding is to be 
confined by the fame reftridions as we have endeavoured 
to eftablilh in its ufe in the latter complaint. That is to 
fay, when pain or forenefs in the chefi, opprefled breath¬ 
ing, general anxiety, and reftleflhefs, are abfent in the 
eruptive ftage of the meafles, w’e fhall have no occafion 
to bleed; and, where thefe are prefent, venefedion, 
either general or local, will almoft always be neceflary. 
But fometimes it happens, that the breathing is very 
hurried, the cough frequent, and the pulfe much quick¬ 
ened, about the firft coming out of the rafli; and yet, if 
we wait a day or fo, we lhall find the refpiration gradu¬ 
ally improve. In irritable children, and efpecially in in¬ 
fants, the refpiration often becomes extremely anxious 
on an attack even of Ample fever, wholly unconnected 
with pectoral inflammation ; and this is more particularly 
the cafe when the bowels are difordered. We muft be 
jnoft careful to difcriminate fuch a ftate of breathing from 
that which commonly attends pulmonic inflammation : 
nor, indeed, is this difficult, becaufe the former is feldom 
permanently the fame, but varies fo much, at different 
times, that the patient will feem now much opprefled, 
and again eafy; whereas, in the latter, there are no 
changes of this fort in the refpiration, for it is fo confi- 
derably opprefled, as never to be entirely eafy. Befides, 
the anxious breathing, which arifes from irritation, is 
generally increafed by the ereCt pofition, and that which 
arifes from inflammation more or lefs diminiflied : in the 
firft, the child now and then obtains pretty tranquil (lum¬ 
bers, with little motion of the cheft ; but, in the laft, the 
fleep is always very difturbed, and the cheft may be feen 
Vol. XIX. No. 1303. 
heavingupand down with an unnatural labour. When 
any part of the pulmonary fyftem is inflamed in children, 
both the diaphragm and the abdominal mufcles are ge¬ 
nerally thrown into an inordinate aClion; fo that, if the 
belly and bread be expofed, one cannot fail of being 
ftruck with their forcible movements. 
What is here faid of pulmonic inflammation is alfo 
applicable to cephalitis, when it comes on during meafles : 
the latter complaint is, however, of very rare occur¬ 
rence. The reduction of pulmonic inflammation is the 
chief objefl in the treatment of meafles. Cupping or 
bliftering to the cheft are occafionally required after the 
general bleeding. For the reft, the adminiftration of fa- 
line medicines, gentle laxitives, and occafional fopori- 
fics, fills up our catalogue of remedies for meafles. Both 
meafles and fcarlet fever are contagious, and aft'edt a per- 
fon once only during life, fubjedt however to the fame 
exception as fmall pox or other fimilar maladies. 
3. Enanthefis urticaria, nettle-ralh : ralh in florid, itch¬ 
ing, nettle-fting, wheals; appearing about the fecond 
day; irregularly fading and reviving, or wandering from 
part to part: fever a mild epanetus. 
The urticaria begins with pain and flcknefs at the fto- 
mach, head-ache, great languor or faintnefs, a difpofition 
to deep, a fenfe of anxiety, an increafed quicknefs of 
the pulfe, and a white fur on the tongue. In two days, 
or fometimes later, wheals appear, with an efflorefcence 
in patches of a vivid red, or fometimes nearly of a crim- 
fon colour. They are preceded by fits of coldnefs and 
fliivering, and are attended with a mod troublefome itch¬ 
ing or tingling, which is greatly aggravated on uncover¬ 
ing the body, or during the night, and which prevents 
reft for many hours. The patches often coaiefce fo as 
to produce a continuous rednefs ; they appear on moft 
parts of the furface, but particularly on the fhoulders, 
loins, nates, thighs, and about the knees. They alfo 
extend to the face; and there is fometimes a red circle 
round the palm of the hand, accompanied with a fenfation 
of violent heat. They appear and difappear irregularly, 
firft on one part, and then on another ; and may be excited 
on any part of the flcin by ftrong fridfion or fcratching. 
During the day the efflorefcence fades, and the wheals 
in general fubiide ; but both return with a flight febrile 
paroxyfm in the evening. The red patches are often 
elevated above the adjoining cuticle, and formdenfe tu¬ 
mours with a hard diftindl border; the interftices are'of 
a dull white colour. When the patches are numerous, 
the face or limb chiefly covered with them appears tenfe 
and enlarged. At the latter end of the diforder the eye¬ 
lids are red and tumefied, and there is often a fwelling 
and inflammation on the fides of the feet. On the ap¬ 
pearance of the eruption, the pain and ficknefs at the 
ftomach are in general relieved; but, when it difappears, 
thefe fymptoms return. The whole duration of the af- 
feSion is feven or eight days. On its decline the ralh 
exhibits a light purple or pink colour, gradually difap¬ 
pears, and is fucceeded by flight exfoliation of the cu¬ 
ticle. 
This diforder occurs principally in fummer, in perfons 
of a plethoric and fanguine habit, efpecially from indul¬ 
gence in eating and drinking. It is often connedled 
with teething and bowel-complaints in infants, w’hom it 
aft’edls at one and at two years old. It appears to aft’edt 
men more than women. A fimilar affedlion is induced 
from eating almonds, muftirooms, herrings, crab-filh, 
mufcles, lobfters, &c. The Urticaria is liable, from the 
form of the ralh, to be miftaken for Rubeola, and, from 
the ftate of the general furface, forRolalia, efpecially on 
a partial examination. Several parts of the furface, and 
all the limbs, fliould be infpedted, as the rafh is often dif- 
tindlly marked in one place, although obfcure in others. 
The charadter of the eruption; the mode of attack ; the 
abfence of catarrh ; and fore throat; the prefence of tin¬ 
gling and itching, &c. will fufficientiy diftinguilh the af- 
fedlion. An emetic of ipecacuanha, followed by a gen- 
4 B tie 
