362 
PATHOLOGY. 
trunk, face, and fcalp. The puftules which occupy the 
breaft and abdomen are generally lefs prominent than 
thofe on the face and arms, contain lefs matter, and ter¬ 
minate rather in fcales than in fcabs. The febrile fymp- 
toms are diminilhed, but not removed, on the appear¬ 
ance of the eruption ; for a conftant erethifm or heftic 
continues during the progrefs of the difeafe. It is ac¬ 
companied by great languor, and by much depreflion 
both-of the l'pirits and mufcular ftrength; by headach 
and pains of the limbs, which are defcribed as rheumatic; 
and by reftleflnefs and impaired digeftion, with irregu¬ 
larity of the bowds. There is commonly alfo fome de¬ 
gree of ophthalmia, affeding both the conjundiva and 
the tarfi; and the fauces are the feat of a flow inflam¬ 
mation, which is commonly accompanied by fuperficial 
ulcerations.” The only effedual treatment feems to be 
to fupport the conftitution by Arid dietetic regulations, 
exercife, &c. and by gentle ftimulants ; as bark, farfapa- 
riila, and the mineral acids, &c. and fo on till the dif¬ 
eafe is worn out. It fometimes lafts for feveral months. 
We prefent our readers, in fig. 1. and 2. Plate XII. with 
a reprefentation of its mod common forms. 
4. Ecpyefis fcabies, the itch: eruption of minute pim¬ 
ples, puftular, veficular, and papular; intermixed or al¬ 
ternating; intolerable itching; terminating in fcabs. 
Found chiefly between the fingers or in the flexures of 
the joints. (Scabies, Cel. Sauv. Vog. Sag. Bateman. Pfora, 
Linn. Cull. Parr.) There are five varieties of this dif¬ 
eafe. 
a. Sc. papularis, the rank itch : eruption of miliary ag¬ 
gregate pimples ; with a papular (lightly-inflamed bafe, 
and veficular apex; puftules fcantily interfperfed ; tips, 
when abraded by (cratching, covered with a minute, glo¬ 
bular, brown fcab. 
This form of itch is liable to be confounded with Li¬ 
chen or Prurigo. It may be diftinguiffied from the former 
by the eruption itfelf; for the unbroken elevations in 
Sc. papularis, when carefully examined, are found to be 
veficular, and not papular; they are often intermixed, 
in particular fituations, with puftules ; and, when they 
break, are fucceeded by fcabs; whereas in Lichen, the 
papulae terminate fpontaneoufly in fcurfy exfoliations. 
In Scabies, the eruption is unconnected with any con- 
ftitutional or internal diforder, and the itching is fevere : 
but in Lichen, there is commonly fome conftitutional af¬ 
fection, and a tingling fenfation, as well as itching. The 
bighly-contagious nature of Scabies will, in many cafes, 
have already manifefted itfelf, and remove all doubt; for 
the Lichen is not thus communicable. In Prurigo, the 
papulae, where no friction has been applied, retain the 
ufual colour of the Ikin, are commonly flatter, or lefs 
acuminated, and prefent no moifture or fcab, except 
when their tops have been forcibly abraded; they are 
not particularly numerous in the parts above mentioned; 
and they remain long diftin&ly papular, without (flowing 
any contagious property. 
j 3 . Sc. veiicularis, (Sc. lymphatica, Bateman.) Watery 
itch : eruptions of larger and more perfect veficles, filled 
with atranfparent fluid, with an uninflamed bafe; inter¬ 
mixed with puftules ; at times coalefcing and forming 
fcabby blotches. The veficles arife with intenfe itching, 
chiefly round the wrifts, between the fingers, on the 
back of the hands, and on the feet and toes : they often 
occur alfo about the axillae, the hams, the bend of the 
elbows, and fofla of the nates, where they are intermixed 
with puftules ; but they do not frequently appear, like 
the papular fpecies, over the breaft and epigaftrium, nor 
on the thighs and upper parts of the arms. In a day or 
two the veficles break ; and fome of them heal under the 
little fcab that concretes upon them. But others in¬ 
flame, and become puftules, which difcharge at length a 
yellow matter, and extend into fmall ulcerated blotches, 
over which a dark fcab is ultimately formed. So that, 
during the progrefs of the eruption, all thefe appearances 
are intermixed with each other: the veficles, and puftules. 
the excoriated blotches difcharging pu 3 , the minute dry 
fcabs, and the larger ones fucceeding the ulceration, may 
be obferved at the fame time. This circumftance confti- 
tutes one of the points of diagnofis between this and 
other veficular difeafes. Of thefe, however, the Herpes 
and Eczema, efpecially the latter, are alone liable to be 
confounded with Scabies veficularis. The Herpes dif¬ 
fers from Scabies in the irregularity of its courfe and ter¬ 
mination, and in the arrangement of its veficles in cluf- 
ters, which are commonly not numerous, and appear on 
thofe parts which Scabies is not very apt to attack. The 
moft difficult diagnofis relates to fome of the varieties of 
Eczema, which clofely refemble this, and fometimes the 
former variety of Scabies; fo that it is not fo much from 
the mere appearances of the eruption, as from the confi- 
deration of the collateral circumftances, that a decifion 
is to be obtained. The Eczema can often be traced to 
diftinft fources of irritation afteCting the (kin, fuch as 
expofure to the folar rays, or to great heat, and to the 
application of acrid fubitances, fuch as lime, fugar, mer¬ 
cury, cantharides, See. It fometimes becomes inflamed 
after the veficles have difeharged their lymph, but it 
does not produce the large phtyzacious puftules ; and, 
although the itching is fometimes intenfe, yet there is 
commonly a tingling and fmarting pain with Eczema, 
that does not belong to Scabies nor is it ever, like the 
latter, communicated by contagion. 
y. Sc. purulenta, the pocky itch, (fee fig. 3. Plate XII.) 
This eruption confifts of diftinft prominent yellow puf¬ 
tules, which have a moderate inflammation round their 
bafes, and which maturate and break in two or three days, 
and then ulcerate, with increafing pain and inflammation. 
Thefe puftules commonly appear firll, and attain the 
largeft (ize, on the hands and feet, efpecially about the 
knuckles and roots of the toes, between the fingers, and 
particularly between the forefinger and thumb, and round 
the wrifts. In thefe fituations, the puftules often exceed 
two lines in diameter, and aflume a prominent globular 
form. If thedifeafe continue a few weeks,the puftules begin 
to appear on the other parts of the body which Scabies ufu- 
ally attacks, efpecially about the axillae, on the back and 
(houlders, and on the arms and thighs near the joints of 
the knee and elbow, in the fofla of the nates, and fome¬ 
times, though of a fmaller fize, even about the epigaf¬ 
trium. In feveral of thefe fituations, where the puftules 
are largeft and numerous, they coalefce, and form irregu¬ 
lar blotches, which ulcerate to fome extent, with hard- 
nefs and elevation of the furface ; but at length hard 
and dry fcabs are formed, which adhere tenacioully for a 
confiderable time. 
The majority of the cafes of Scabies purulenta occur 
between the age of feven years and the period of puberty. 
It cannot be ealily miftaken for Impetigo, when it oc¬ 
curs in patches, in confequence of the large fize, the 
greater prominence, and comparatively fmall number, of 
its puftules; not to mention the abfence of the intenfe 
itching, and of contagion, in the former. From the Por- 
rigo favofa affeCting the extreituties, it will be diftin- 
guiflied chiefly by its fituations about the fingers, axillae, 
fofla natum, and flexures of the joints, antLby the total 
abfence of the eruption from the face, ears, and fcalp ; by 
the nature of the difcharge ; and by the thin, hard, and 
more-permanent, fcab, which fucceeds, inftead of the 
foft, elevated, femi-tranfparent, fcab, formed by the vif- 
cous humour of the favi. The only other difeafe, with 
which the Scabies purulenta has any affinity, is the Ec¬ 
thyma : but the hard, elevated, vivid red or livid bafe, 
which furrounds the puftules of Ecthyma, their flow pro¬ 
grefs both towards maturity and in the courfe of fuppu- 
ration, the deep ulceration, with a hard raifed border, 
and the rounded imbedded fcab, which fucceed, as well 
as the diftinCt and feparate diftribution of them, will af¬ 
ford the means of diferimination ; to which the inceflant 
itching and the contagious property of Scabies, may be 
added. 
& Sc. 
