PATHOLOGY. 
300 
marafmus, who are ill-fed, uncleanly, and not fufficiently 
exercifed; but it is generally allowed, at leaft in this 
country, to arife chiefly from infection. The phyficians 
of the Hopital St. Louis, a very well filled depot for 
cutaneous difeafes, aflert that the contagious power of 
tinea have been much over-rated; and that it is often 
impoflible to communicate by inoculation. The fame 
authorities aflert, that it is invariably hereditary. Porrigo 
galeata is confefledly a very difficult difeafe to cure. 
With regard to the confiitutional treatment, this is of 
the utmoft confequence. It has appeared to us, that to 
the negled of this circumftance in the treatment of the 
early ftage of Porrigo moll of thofe old and inveterate 
cafes which are fo often met with, are to be attributed. 
A recent author (Plumbe’s Pradical Treatife on Ring¬ 
worm of the Scalp, 1821,) indeed, aflerts the contrary; 
but we have had too many inflances handed down to us 
of the moll dangerous phlogofes caufed by the repulfion, 
and cured by the appearance, of this eruption, to enter¬ 
tain the leaft concurrence in this opinion. The firft ftage 
of porrigo is evidently inflammation. It is, in moft cafes, 
that irritative kind of inflammation almoft always con- 
neded with a bad ftate of general health. In the majo¬ 
rity of cafes, a ftrid attention to the diet and alvine dif- 
charges is all that is required. We have feen cafes, (iow- 
ever, in which it was alfo necefiary to remove general 
plethora by fmall bleedings, a ftate of body which natu¬ 
rally increafes in a great degree all inflammatory fores. 
The fecretions of the kidneys fhould be moft efpecially 
excited in P. galeata. The fympathy between the fecre- 
tion of urine and of fweat is obvious enough : hence 
terebinthinates have been found ufeful in porrigo. In 
the fame ftage much will depend on the local meafures 
which are ufed. Thefe fhould be (in the inflammatory 
ltage) confined to the following : 1. The head fhould be 
frequently waflied and well fomented with tepid water ; 
the hair in fome parts fhaved ; but, when fores are plen¬ 
tiful, carefully cut the loofe hairs, and thofe which are 
quite loofe may be taken out with a pair of pincers. 2. 
After the ablution; the head fhould be well dried with 
a foft cloth. 3. A mild ointment of fpermaceti and fuet 
to be fpread on lint, and applied over the fore parts; a 
cap being placed over this, which muft fit pretty tight; 
for preflure will do fome good in this complaint. Thefe 
little attentions, unimportant as they appear, are of the 
higheft confequence in the treatment of Porrigo. As to 
how long thefe meafures are to be perfifted in, muft be a 
matter entirely at the difcretion of the praditioner. 
Certain it is, that moft men err by ftimulating too foon; 
hence, if no very great amendment took place, we fhould 
not depart from this plan too liaftiiy, and, at all events, 
not while rednefs and extreme tendernefs remained, nor 
until a dry and indolent ftate of the fcab is fufficiently 
apparent. It is in this ftage that ftimuli are requifite: 
and of thefe the records of medicine fnrnifh a large 
number. Moft of thefe have in fome cafes cured Porrigo; 
but, like all medicines of this clafs, they are very uncer¬ 
tain in their operation. They muft be ufed at firft in 
fmall proportions, and may be gradually augmented to 
fuch an excefs, that even a blifter may ultimately be 
borne. The ftimuli moft in requefl are the mercurial 
ointments, as the ung. liydrargyri prscipitati, hyd. 
nitrico-oxydi,and efpecially of the hydrargyrus nitratus ; 
thofe prepared with fulphur, tar, hellebore, and turpen¬ 
tine, and the unguentum elemi. To thefe may be added, 
on more ,dubious authority, preparations of muftard, 
ftaves-acre, black pepper, capficum, galls, rue, and other 
acrid vegetable fubftances. Lotions containing the ful- 
phates of zinc and copper, or the oxymuriate of mercury, 
in folution, are occafionally beneficial. The more cauftic 
fubftances are often extremely fuccefsful. A lotion 
containing from three to fix grains of the nitrate of 
filver in an ounce of diftilled water, has removed the 
difeafe. Touching the patches with themuriated tincture 
of iron, or with any of the mineral acids, flightly diluted. 
in fome cafes removes the morbid cuticle, and the new 
one aflumes a healthy adion. The application of a blifter, 
in like manner, fometimes effedually accomplifhes the 
fame end. Alibert recommends a mixture of equal parts 
of fulphur and charcoal incorporated with various pro¬ 
portions of cerate. 
y. P. favofa, honey-comb fcall or tetter, (fig. 3.) Puf- 
tules common to the head, trunk, and extremities; pea- 
fized ; flattened at the top; in clufters, often uniting; 
difcharge fetid; fcabs honey-combed, the cells filled with 
the fluid. 
This difeafe begins with an eruption of large foft ftraw- 
coloured puftules. Thefe are not in general globular, 
with a regularly-circular margin; but fomewhat flattened, 
with an. irregular edge, and furrounded by a flight in¬ 
flammation. They occur on all parts of the body; fome¬ 
times on the fcalp alone, and fometimes on the face, or 
on the trunk and extremities only; but moft commonly, 
they fpread from the fcalp, efpecially from behind the 
ears, to the face, or from the lips and chin to the fcalp, 
and occafionally from the extremities to the trunk and 
head. They are ufually accompanied with confiderable 
itching. Children from fix months to four years of age 
are moft liable to this eruption; but adults are not un- 
frequently affeded with it. 
The puftules, efpecially on the fcalp, appear at firft 
diftind, though near together; but on the face and ex¬ 
tremities they generally rife in irregular clufters, be¬ 
coming confluent when broken, and difcharging a vifcid 
matter, w^hich gradually concretes into greenifh or yei- 
lowifti femi-tranfparent fcabs. The difeafe extends, by 
the fucceflive formation of new blotches, which fome¬ 
times cover the chin, or furround the mouth, and fpread 
to the cheeks and nofe; and on the fcalp the ulceration 
ultimately extends, in a fimilar manner, over the whole 
head, with a conftant difcharge, by which the hair and 
moift fcabs are matted together. Under the laft-mentioned 
circumftances, pediculi are often generated in great num¬ 
bers, and aggravate the itching and irritation of the dif¬ 
eafe. On the face, too, a fimilar aggravation of the 
fymptoms is occafioned, in children, by an inceflant 
picking and fcratching about the edges of the fcabs,which 
the itching demands, and by which thefkin is kept fore, 
and the ulceration extended; while the fcabs are thick¬ 
ened into irregular mafles, not unlike a honey-comb, by 
the accumulating and concreting difcharge. On the 
lower extremities confiderable ulcerations fometimes 
form, efpecially about the heels, and roots of the toes ; 
and the ends of the toes are fometimes ulcerated, the 
puftules arifing at their fides, and even under the nails. 
The ulcerating blotches feldom continue long, or 
extend far, before the lymphatic fyftem exhibits marks 
of irritation, probably from the acrimony of the abforbed 
matter. When the fcalp or the face is the feat of the 
difeafe, the glands on the fides of the neck enlarge and 
harden, being at firft perceived like a chain of little tu¬ 
mours, lying loofe under the Ikin ; and the fubmaxillary 
and parotid glands are often affeded in a fimilar manner. 
At length fome of them inflame, the ficin becomes dis¬ 
coloured, and they fuppurate fiowly, and with much 
pain and irritation. The eruption, in thefe fituations, is 
likewife often accompanied by a difcharge from behind 
the ears, or from the ears themfelves, with a tumid upper 
lip, and inflammation of the eyes, orobftinate ulcerations 
of the edges of the eyelids. When the eruption appears 
on the trunk, although the puftules there are fmaller and 
lefs confluent, and the fcabs thinner and lefs permanent, 
the axillary glands are liable to be affeded in the fame 
way. 
The difcharge from the ulcerated furfaces, efpecially 
on the fcalp, when the crufts and coverings are removed, 
exhales an offenfive rancid vapour, not only affedingthe 
organs of fmell and tafte, but the eyes, of thofe who 
examine the difeafed parts. The acrimony of the dif¬ 
charge is alfo manifefted by the appearance of inflamma¬ 
tion, 
