PATH 
fpringing from within. See p. 273.] Cutaneous blufh. 
Generic characters—Simple cutaneous rofe-coloured ef- 
fiorefcence, in circumfcribed plots, with little or no ele¬ 
vation. 
On coming to the confideration of cutaneous difeafes 
ftriftly fo called, it will be necefiary to make a few pre¬ 
liminary remarks. It will be recollected, that in p. 141 
of this article, we have expreffed our concurrence in the 
opinion which attributes the majority of cutaneous de- 
faedations to gaftric or inteftinal irritation. In that place 
alfo fufficient evidence of this frequent connexion has 
been adduced. An objection, however, is in force 
againft this mode of confidering the difeafes in queftion; 
.that, while gaftric or inteftinal irritations are but few in 
number, cutaneous maladies are extremely multiform ; 
and hence it may be inquired, Can fo many and fucli 
oppofite appearances refult from one caufe ? 
Let us examine the matter a little clofely. Cutaneous 
difeafe is evidently a difeafe of the fecernents of the (kin; 
fometimes this dileafe is accompanied, either as a caufe 
or confequence, with inflammation : i. e. turgefcence and 
-heat of the fubjacent red veffels ; but fometimes this is 
wholly abfent, and the difeafe of the fecernents is the 
only malady. Now this difeafe of the fecernents is fup- 
pofed to vary according to the produCt which is fecreted ; 
and on this variation have the claflifications of cutaneous 
difeafes'by Willan and Bateman been folely founded. 
Thus, when inflammation of the fubjacent red veffels 
takes place, the papula, or pimple, (“a very fmall and acu¬ 
minated elevation of the cuticle, with an inflamed bafe, 
very feldom containing a fluid, or fuppurating, and 
commonly terminating in fcurf,”) is found. When the 
inflammation goes on to fuch a degree as to diforganize 
the (kin, fquama, or fcales, (“laminae of morbid cuticle, 
hard, thickened, whitifli, and opaque,” and irregular 
layers of fkin called crujls, or over ulcers J'cabs,) are ob- 
ferved. The flmpleft difeafe of the lkin is that in which 
.the fecernents admit red blood, and fecretion is at once 
fufpended. This forms the exanthema, or rafh ; (“ fuper- 
ficial red patches, varioufly figured, and diffufed irregu¬ 
larly over the body, leaving interftices of a natural co¬ 
lour, and terminating in cuticular exfoliations.”) When 
the above veffels fecrete iri fmall quantities, water, which 
becomes opaque, and is fucceeded by fcUrf or crufts, 
they are named veficles; when in large quantities like a 
blifter, bulla, or bleb. Laftly, when pus is fecreted in 
the cutaneous elevation, it is called a puflulu, or puftule. 
The puftule has in all cafes an inflamed bafe. Dr. Bate¬ 
man gives four varieties of it. 
a. Phlyzacium; a puftule commonly of a large fize, 
raifed on a hard circular bafe, of a vivid red colour, and 
fucceeded by a thick, hard, dark-coloured fcab. 
b. PJydracium; a fmall puftule, often irregularly cir- 
cutnfcribed, producing but a flight elevation of the cu¬ 
ticle, and terminating in a laminated fcab. Many of the 
pfydracia ufually appear together, and become confluent; 
and, after the difcharge of pus, they pour out a thin 
watery humour, which frequently forms an irregular in- 
cruftation. 
<•. Achor; a fmall acuminated puftule, containing a 
ftraw-coloured matter, which has the appearance and 
nearly the confidence of drained honey, and fucceeded by 
a thin brown or yellowifh fcab. 
d. Faviis, is larger than the achor, flatter, and not acu¬ 
minated, and contains a more vifcid matter; its bafe, 
which is often irregular, is flightly inflamed ; and it is 
fucceeded by a yellow, femitranfparent, and fometimes 
cellular, fcab, like a honey-comb; whence i£ has obtained 
its name. 
To thefe we may add the tubercle and the wheal. The 
firft is a fmall hard fuperficial tumour, circumfcribed and 
permanent, or fuppurating partially; and the wheal is 
the fame appearance as is produced by a (mart ftroke 
with a whip on the naked fkin, Itfeems a fudden accu- 
Vol.XIX. No. 1308. 
OLOGY. 351 
mulation of the fluids of the part, which goes off as the 
veffels regain their natural powers. 
To return to the fubjeft we were reafoning upon. We 
perceive, therefore, two agents concerned in cuta¬ 
neous difeafes : the fecernents of the fkin, and the red 
blood-veflels of the fubjacent tiflue. We obferve, that, 
according to the peculiar irritation which affefts them, 
both thefe veffels put on different appearances. Now on 
the one hand, the circular form of one eruption is con- 
trafted with the irregular form of another, and the mor¬ 
bid produff of this is quite different from the difeafed 
fecretion of another. The difeafes of the ikin in which 
the fanguineous ftrufture is implicated are few in number, 
and for the moft part eafily traced to the caufe of morbid 
blood on the one hand, or atmofpherical changes on the 
other. But the difeafes which have their feat moft ftriftly 
in the fecernents of the fkin, and which are by far the 
moft numerous, cannot be fuppofed to fuffer from atmol- 
pheric changes, fince thefe could merely operate to reduce 
or increafe the quantity of blood in the blood-veflels of 
the fkin; and in fa ft are not more frequent in hot or cold 
climates than in temperate ones, though we allow that 
they are more violent in hot ones when once formed, by 
reafon of the conlequent inflammation which heat fo 
naturally excites. And, even were thefe impreflions al¬ 
lowed to have much force, wefhould be furprifed to find 
that fo many kinds of difeafe follow the very Ample 
caufes of heat or cold. 
It is to that portion of the cutaneous expanfion which 
lines the alimentary canal, which is expofed to a thoufand 
different impreflions from foreign bodies, from excels or 
alteration in its own fecretions, or of thofe fecretions 
poured fo plentifully into it, which moreover is fo clofely 
connefted by nervous fympathy with the external fkin, 
that the moft trifling ailments of the one alter the fecre¬ 
tion and aftions of the other, that we muft look for the 
common caufe of diftention of the lkin. Befides the con¬ 
nexion between the gaftric and cutaneous irritation by 
means of nervous fympathy, the alteration which im¬ 
paired digeftioaeffefts in the quality of the blood, may 
bring on cutaneous defaedations ; but it feems that the 
maladies produced by this caufe as deeply implicate the 
fubjacent tiflue as the fkin, and therefore are not properly 
to be claffed with cutaneous diforders. Thus, Porphyra 
is very properly feparated by Dr. Good from this clafs. 
A great number of cutaneous difeafes are infeftious. 
The cure, therefore, of all cutaneous maladies may be 
attempted with the following indications. The firft is to 
reftrain the aftion of the fanguiferous fyftem, in thofe 
maladies or in thofe ftages of maladies in which their ac¬ 
tion is exceflive. This is chiefly effefted by bleeding, 
by cooling and fedative lotions. The fecond is, to re¬ 
move the morbid fecretions which are applied to the ali¬ 
mentary canal, and which caufe the difeafe. The cor- 
reftion of bile has been followed by the cure of trouble- 
fome cutaneous diforders ; and there is fcarcely a medi¬ 
cine capable of producing a powerful change in the fecre¬ 
tions of the digeftive organs but what has, on a few oc- 
cafions, performed furprifing cures. But the moft pliilo- 
fophical and fure method of proceeding is to reftore the 
funftion of the alimentary canal by proper regulations 
as to diet and exercife, and the ftate of the alvine fecre¬ 
tions. In many cafes this is all that is necefiary; but in 
forne, notwithftanding the digeftive and fanguineous 
organs are in a very tolerable ftate of health, the difeafe of 
the lkin will remain unabated. Under thefe circumftan- 
ces, it will be necefiary to apply fome medicine that will 
ftimulate the fecernents in a different mode to that fti- 
mulation imparted by their nerves. In different difeafes 
different ftimuli will be necefiary; but this can only be 
known by experiment. In fome, the ftimulating agent 
required is almoft invariable in its fuccefsful operation ; 
as fulphur for the cure of itch ; in others, the greateft un¬ 
certainty is met with, as in fome forms of impetigo. 
4 X Another 
