is an acute or chronic disease. If acute, he must treat it according to the nature and violence of the symptoms; we must not be sparing of blood-letting to obviate internal inflammations, and must give diluents, refrigerants, mild sudorifics, and gentle purgatives and anodynes; upon these depends the cure of almost all acute disease, and the proper choice and succession of them indicate the ability of the physician.

But if the patient is labouring under a chronic disease, we must do every thing to recall the morbific matter outwardly, and this is one of the most difficult things in medicine, for the humours once displaced are not easily controuled, and can seldom be brought back to their former seat; we must however neglect no endeavours to reproduce the itch; and for this purpose we must employ mild sudorifics, in drinks, decoctions, broths, &c. If this does not succeed, we must apply blisters to the parts where it first appeared; we must also make the patient go to bed to a person affected with the itch, and wear his shirt. These means have sometimes succeeded in making the itch reappear on the skin, so that the patient has been relieved, and freed from all that he before suffered, and the itch has afterwards been cured by remedies suited to its nature and causes.

If the itch does not at all re-appear, and does not follow the sweats, we must dilute well, and drive it forth by stool and urine. Experience and daily practice show us the great consent existing between the skin, the kidneys, and the bowels; and that what cannot pass off by one way will by another. We must therefore employ purgatives and diuretics, without ever forgetting mild diaphoretics and sudorifics, which may be usefully combined together, all having a tendency to dislodge the morbific matter, and drive it outwardly.

Lastly, If the repelled itch does not give way to any of the methods we have proposed, we must open an issue upon the arm, or even a second, upon the leg, to afford a more free and uninterrupted passage to the morbific matter by these drains.

Although I have said the repelled itch produces very ill effects, I do not believe, that when it once appears on the surface of the skin, it can return inwardly; I would only be understood to mean, that the itchy matter cannot. make its way through the skin when its pores are stopped: by pomatum, ointments, &c. and not being suffered to pass out, is necessarily retained, and causes disease in internal parts. We may however be assured, that humours arrested

by

by the skin may be thrown inwardly, as we find that mercury enters the system by that mode, and even that ointments, or liniments against worms, produce their effects upon the intestines, when applied to the abdomen or navel, especially in young children.

S. HERPES.

This disease nearly resembles the itch, especially the first species of it,, which I call the farinaceous, furfuraceous, or miliary, wherein we may perceive upon the skin something resembling meal, or very fine bran, which falling off in almost imperceptible scales, discovers the skin somewhat reddish, and covered with small points, resem→ bling millet or mustard seed, accompanied by some heat and itching. This meal or bran, which falls off in small scales by the least rubbing, is soon after renewed, and again falls off in succession.

The second species is the crustaceous, characterized by crusts, more or less thick, which cover the affected part; they are usually dry, they separate and fall off, with some pain, leaving the skin red and tender, but new crusts soon succeed, and again fall off. This, like the former species, is accompanied by itching and heat, and even with much pungent smarting; it is dry and stationary, occupying always nearly the same place, and not spreading like the first; it does not grow larger and deeper in its progress, nor is it moist like the third species.

The third and last species is the spreading herpes, moist or running; it is red, attended with heat, inflammation, and great itching; it discharges a greyish or yellowish viscid serosity, sometimes reddish, and very hot and acrid;' it corrodes all the neighbouring parts, often extending itself to a great distance. As in its progress it becomes larger and deeper, and ulcerates the part it attacks, and as it is sometimes accompanied with a sanious or purulent discharge, we give it the name of ulcerous herpes.

Is there no difference, it may be said, between the itch and the furfuraceous herpes, since both these diseases, according to you, have the same origin, and occupy the same seat? I answer, the only difference which appears in the symptoms or effects of these two diseases depends upon the different quality or quantity of the heterogeneous matters carried off by transpiration. If, for instance, this is very gross and dry, and charged with salts or sulphur, it. will produce the dry itch and large pustules; if these principles are more diluted, it will be the moist itch; and last

ly,

ly, if the salts and sulphurs contained in the humours are more subtilized, and rendered volatile and active, the miliary herpes will be produced; for, indeed, upon the difference in the humours, and their principles upon the strength or weakness of our fibres, and in a word, upon their different tone and action, depend different constitutions, and thence arise the various kinds of diseases to which we are liable.

It appears from what has been said, that the herpes generally arises from an internal cause, from some depraved humours, which kind nature throws outwardly; we must therefore regard this disease as salutary; it serves as a drain for whatever is hurtful in the mass of humours, and they are thereby purified. It becomes very important therefore, not to stop this drain, but to afford an escape to the humour which appears under the form of meal or bran, for if the herpes either disappears of itself, or is repelled by topical application, there is the greatest danger of the patient falling into some violent, or even fatal disease, as will be seen in the following histories.

A man, 35 years of age, in extremely good health, had for a long time, a herpes between his thumb and fore-finger; it was furfuraceous and red underneath, not spreading, but quite at a stand; he felt no inconvenience from it but an itching, which occasioned him to rub or scratch it. Some person imprudently gave him a medicine, the composition of which I am unacquainted with; he rubbed the affected part with it, and the next day the herpes disappeared; but being called to him two days afterwards, I found him in a high fever, his face extremely red and swelled, complaining of a heaviness and pain in his head, and great heat and thirst; what is most remarkable is, there was a discharge from his face of a serosity so acrid and sharp, that it corroded whatever part it run over, as if it had been touched with liquid caustic. Seeing him in this deplorable condition, I immediately bled him, and repeated it several times, from the arm and the foot; I gave him softening emulsions and cooling laxatives and enemas; by these means, avoiding all topical application, I allayed the heat of the humours, the fever, the redness of the face, and the thirst. Afterwards he was gently purged, the fever entirely left him, the swelling of the face and discharge subsided, and warm fresh water baths, and the use of asses milk, completed the cure, preventing also the return of the herpes, which never again appeared.

A merchant, about 60 years old, very fat, and of a full gross

gross habit, was subject to a furfuraceous herpes, which had continued on one of his knees many years, attended with a troublesome itching; he had often requested me to give him some medicines to relieve this, but I always refused, because I knew this herpes secured him against every other disease, and he was, except that, in perfectly good health. One day he perceived himself quite relieved from his itching, and could no longer see the herpes, which had completely disappeared, by reason of his having felt some chagrin on some occasion; but it only raged the more vehemently within, for in four days afterwards he was seized with such violent convulsions of the muscles of the thorax, and such acute pain, that he could scarcely move or breathe, and uttered doleful cries. Being called to him, I found him in a complete tetanus; I bled him both in the arm and foot, and although he had no fever, the blood always appeared very sizy. I also gave him mild sudorifics, laxative glysters, and anodynes, and without having recourse to the affusion of cold water upon the thorax, as recommended by some practitioners, I had the satisfaction of seeing the pain and oppression in the chest daily diminish, and the power of motion increase; but as the disease did not completely go off, I thought it right to recall the herpes to the knee which it had previ ously occupied; for this purpose I covered it with a vesieatory, and when the discharge took place, the pains and oppression which he still felt in a small degree, completely left him, the herpes re-appeared, and the patient recovered perfect health. He continued quite well for about five years, when the herpes again disappeared, whether spontaneously, or from what cause, I do not know; the patient became drowsy and fell into an apoplexy, from which he could not be recovered.

To the Editors of the Medical and Phyfical Journal.

GENTLEMEN,

ON perusing the last Number of your useful Miscellany,

my attention was drawn to Mr. Headley's Cases and Observations on Ophthalmia. The purport of this paper seems to be to call the attention of medical men to the adminis

tration

nation of the bark in the intermittent form of this disease. The hint of the use of this remedy, in such cases, he candidly confesses, he received from the late Mr. Saunders.

As the tenour of this communication might lead some tosuppose, that the efficacy of this bark in ophthalmy was not generally known, I beg leave to observe to Mr. H. that it has been used for many years in that intermittent form of the disease to which he alludes. To prove this assertion, it is only necessary to refer to the works of that celebrated oculist Mr. Ware. Its use is first mentioned in his Observations on Scrophulous and Intermittent Ophthalmy, published in 1792, and afterwards in the first volume of his Chirurgical Observations, relative to the eye, &c. promulgated in 1805.

Here, however, he has judged it necessary to caution practitioners against its indiscriminate use, adding, "I feel it my duty to caution against the hasty adoption of this remedy, since the instances in which it is likely to prove useful are extremely rare, and if it be improperly employed in such large doses, it will increase the inflammation and much aggravate all the symptoms." Notwithstanding this, it appears to have been useful in several of the cases which Mr. Ware relates. He, however, gives the preference, in the intermittent form of the disease, to a solution of oxymuriate of mercury taken inwardly, in about the proportion of a quarter of a grain every night in any proper vehicle. Of the good effects of this remedy he thus expresses himself, "I have the satisfaction to add, that in a great variety of such cases, I have afforded the most striking relief by means of it, after the cortex peru vianus and various other medicines had been found totally incompetent for this purpose."

I may add, that I have had an opportunity of using it in two instances, in which its application, both internally and externally, speedily produced a cure, after the common means were tried in vain.

As to the cinchona, there is no doubt but it will be found useful as a powerful tonic, in many of these chronic, debilitated, and intermittent forms which the disease often

assumes.

If I have used any expression in these cursory remarks, which may in the least tend to hurt Mr. H's feelings, I ask pardon, and beg leave to assure him, that the diffusion of useful knowledge, and not criticism, was my aim.

I am, &c.

W. HAMILTON.

Ipswich, August 6, 1810.