of fmall-pox there is often a very confiderable putrefcency of the fluids, as appears from petechiæ, fron ferous veficles, under which the fkin fhows a difpofition to gangrene, and from bloody urine or other hæmorrhages; all of which symptoms often attend this disease. In the confluent fmallpox alfo, the fever, which had only fuffered a re miffion at or immediately after this period, is of ten renewed again with confiderable violence. This is called the secondary fever, and is of various duration and event.

643. Caules, &c. The fmall-pox is originally produced by contagion, which acts as a ferment to the fluids of the human body, and affimilates a great part of them to its own nature; cr, at leaft, a fmall quantity of contagious matter intro. duced is fomehow multiplied and increafed in the circulating fluids. This quantity paffes again out of the body, partly by infenfible perfpiration, and partly by being deposited in puftules. The caufes which determine more of the variolous matter to país by perspiration, or to form puftules, are probably certain circumftances of the fkin, which determine more or lefs of the variolous matter to ftick in it, or to pafs freely through it. The circumftance of the fkin, which feems to determine the variolous matter to tick in it, is a certain ftate of inflammation depending much on the heat of it: thus we have many inftances of parts of the body, from being more heated, having a greater number of puftules than other parts. Thus parts covered with plafters, especially thofe of the ftimulant kind, have more puftules than others. Certain circumstances alfo, fuch as adult age, and full living, determining to a phlogistic diathefis, produce a greater number of puftules, and vice verfa. It is therefore probable, that an inflammatory itate of the whole fyftem, and more particularly of the skin, gives occafion to a great er number of puftules; and the caufes of this may produce moft of the other circumstances of the confluent small-pox, such as the time of eruption, the continuance of the fever, the effufion of a more putrefcent matter, and lefs fit to be converted into pus, together with the form and other circumstances of the puftules.

644. Prognofis. The more exactly the difeafe retains the form of the distinct kind, it is the fafer; and the more completely the difeafe takes the form of the confluent kind, it is the more dan gerous. It is only when the diftinct kind shows a great number of puftules on the face or otherwife, by fever or putrefcency, approaching to the circumstances of the confluent, that it is attended with any danger. In the confluent kind the danger is always very confiderable; and the more violent and permanent the fever is, the greater the danger, efpecially in proportion to the increafe of the fymptoms of putrefcency. When the putrid difpofition is very great, the difeafe Sometimes proves fatal before the 8th day; but a moft cafes death happens on the 11th, and fome times not till the 14th or 17th day. Though the fmal-pox may not prove immediately fatal, the me violent kinds are often followed by a morlad ftate of the body, fometimes of very danerous event. These confequences, fays Dr Culmay be imputed fometimes to an acrid mat

ter produced by the preceding difeafe, and depo. fited in different parts; and fometimes to an inflammatory diathefis produced and determined to particular parts of the body.

645. Cure. The art of medicine hath never yet afforded a method of preventing the eruption of the small-pox after the contagion is received; though the recent important discovery of inoculation by the Cow-pox affords an effectual preventive of receiving the variolous contagion. (See INOCULATION, § 8; and VACCINE INOCULA TION.) But the moft dreadful symptoms and confequences of the natural fmall-pox are prevented, and the disease itself rendered more mild by INOCULATION with its own variolous matter. (See INOCULATION, §7.) The mere giving of the infection artificially could make no difference in the nature of the difeafe, were it not that certain precautions are used in the cafe of those who are inoculated, which cannot be used in that of thofe who receive them_naturally.-These mea fures, according to Dr CULLEN, are chiefly the following: 1. Choofing for the subject of inoculation perfons otherwife free from disease, and not liable from their age or otherwise to any incidental difeafe. 2. Choofing that time of life; and, 3. That feafon of the year, which are most favourable to a mild disease. 4. Preparing the person to be inoculated, by abftinence from animal food for fome time before inoculation: and, 5. By mercuria! and antimonial medicipes. 6. Taking care at the time of inoculation to avoid cold, intemperance, fear, or other circumstances which might aggravate the future disease. 7. Both before and after inoculation, taking care to avoid external heat, either from the fun, artificial fires, warm chambers, much clothing, or being much in bed; and on the contrary, expofing the patient to a free and cool air. 8. Upon the appearance of the eruptive fever, rendering that moderate by purgatives, cool. ing and antifeptic acids; and efpecially by expofing the perfon frequently to a cool, and even a cold air, at the fame time giving freely of cold drink. 9. After the eruption, continuing the application of cold air, and the ufe of purgatives, during the course of the disease, till the puftules are fully ripened. On these measures Dr Cullen obferves, that, as the common infection may often feize perfons under a diseased state, which may render the small-pox more violent, it is evident that inoculation must have a great advantage by avoiding fuch concurrence.

646. But it appears to be now quite unnecessary to quote Dr CULLEN, Baron DIMSDALE, or any other author, however eminent, farther upon this fubject, as inoculation with the fmall-pox has of late very generally given place to inoculation with the Cow-pox; the advantages of which are now not only acknowledged by the moft eminent phyficians in Europe, but fuch measures have been lately adopted at London (Jan. 19, 1803), as in all probability will render the vaccine inoculation univerfal, and, of confequence, may foon extirpate the small-pox throughout Britain. See VACCINE INOCULATION.

647. Until that desirable object, however, shall be accomplished, it is proper to confider the treatment of the small-pcx, when the fymptoms are

violent,

violent, as they fometimes are, after every precaution has been used, from a putrefcent tendency of the fluids. When, therefore, from the prevailing of small-pox as an epidemic, and more efpecially when it is known, that a person not formerly affected with the disease has been expofed to the infection, if such person should be attacked with fever, there can be little doubt that it is the fever of the small-pox, and therefore he is to be treated in every respect as if he had received the disease by inoculation. He is to be freely expofed to cool air, to be purged, and to have cooling acids given liberally. If these measures moderate the fever, nothing more is neceffary: but, if the nature of the fever be uncertain; or if, with fufpicions of the small-pox, the fever be violent; or even if, knowing the diftemper to be the smallpox, the measures abovementioned do not mode. rate the fever fufficiently, venefection will be proper; more efpecially if the perfon be an adult, of a plethoric habit, and accustomed to full living. In the fame circumftances it will be proper to give a vomit; which is ufeful in the beginning of all fevers, and especially in this, where a determination to the ftomach appears by pain and sponta. neous vomiting. It often happens, especially in infants, that, during the eruptive fever of the fmall-pox, convulfions occur. Of these, if only one or two fits appear on the evening preceding the eruption, they give a prognoftic of a mild dif. eafe, and require no remedy: but if they occur more early, are violent, and often repeated, they are very dangerous, and require a speedy remedy; and here the only effectual medicine is an opiate in a large dose. These are the remedies neceffary during the eruptive fever; and if, upon the eruption, the puftules on the face are diftinct, and their number few, the disease requires no further remedies. But when, upon the eruption, the number of pimples on the face is confiderable; when they are not distinct; and especially if, upon the 5th day, the fever does not fuffer a confiderable remiffion; the difeafe ftill requires a great deal of attention. If, after the eruption, the fever fhall ftill continue, the avoiding of heat, and the continuing to expose the body to a cool air, will ftill be proper. If the fever be confiderable, with a full hard pulse, in an adult, a bleeding will be neceffary, and more certainly a cooling purga tive: but it will be seldom neceffary to repeat the bleeding, as a lofs of ftrength very foon comes on; but the repetition of a purgative, or the frequent ufe of laxative glyfters, is advantageous. When a lofs of ftrength, with other marks of a putrefcent tendency of the fluids, appears, the Peruvian bark must be given in fubftance, and in large quantity; the ufe of acids and of nitre is advantageous, and wine should also be given freely. From the 5th day of the disease throughout the whole course of it, it is proper to give an opiate once or twice a-day: taking care at the fame time to obviate coftiveness, by purgatives or by laxative glyfters. From the 8th to the rith day of a violent difeafe, it will be proper to lay on blifters fucceffively on different parts of the body, and without regard to the parts being covered with puftules. Blifters are alfo to be applied to the external fauces, in case of difficult deglutition, and

vifcid faliva and mucus, which are thrown out with difficulty, at the fame time that detergent gargles are to be used. The rentedies abovementioned are often proper from the 5th day till the fuppuration be finished. But after that period the fever is fometimes continued and increased; fometimes, when there was little fever before, the fecondary fever arises, continues with confider. able danger, and requires a particular treatment. When this fever follows the diftinct fmall-pox, and the pulfe is full and hard, the cafe is to be treated as an inflammatory affection, by bleeding and purging; but the fecondary fever which fol lows the confluent kind is to be confidered as a putrid disease, and bleeding is improper. Some purging may be neceffary; but the remedies to be chiefly depended upon are the Peruvian bark and acids. When the fecondary fever first appears, whether after a diftinct or confluent small-pox, it is useful to exhibit an antimonial emetic in fuch a manner as to produce fome vomiting. For preventing the pits which fucceed the small-pox, no method hitherto proposed seems to be sufficiently certain.

648. GENUS XXIX. VARICELLA. CHICKEN Pox. Varicella, Vog. 42.-Variola lymphatica, Sauv. fp. 1.-Anglis, The CHICKEN-POX, Edin. Med. Effays, vol. ii. art. 2. near the end. Heberden, Med. Tranfac. art. 17.

649. This is in general a very flight disease; and is attended with fo little danger, that it would not merit notice, if it were not apt to be confounded with the fmall-pox, and thus give occa fion to an opinion that a perfon might have the fmall-pox twice in his life, or to deceive into a falfe fecurity those who have never had the fmallpox, and make them believe that they are fafe when in reality they are not. This eruption breaks out in many, according to Dr Heberden, without any illness or previous fign; in others it is preceded by a little degree of chillness, laffitude, cough, broken fleep, wandering pains, lofs of appetite, and feverish ftate for three days. In fome the chicken-pox make their first appearance on the back. Moft of them are of the common fize of the small-pox, but some are lefs. Dr Heberden never faw them confluent, nor very numerous. The greatest number was about 12 in the face and 200 over the reft of the body. On the fir day of the eruption they are reddish. On the ad there is at the top of moft of them a very fmall bladder, about the fize of a millet-feed. This is fometimes full of a watery and colourless, fometimes full of a yellowish liquor, contained be tween the cuticle and skin. On the 2d, or at fartheft on the 3d day from the beginning of the eruption, as many of thefe pocks as are not broken feem arrived at their full maturity; and those which are fulleft of that yellow liquor very much refemble the genuine fmall-pox on the 5th or 6th day, especially where there is a larger fpace than ordinary, occupied by the extravafated ferum. In moft cafes, either on the first day that this little bladder arifes, or on the day after, st tender cuticle is burft by the accidental rubbing of the clothes, or by the patient's hands, to allay the itching which attends this eruption. A thr scab is then formed at the top of the pock, ar

the

the fwelling of the other parts abates, without ever being turned into pus, as in the fmall-pox. Some few escape being burft; and the little drop of liquor, contained in the veficle at the top of them, grows yellow and thick, and dries into a fcab. On the sth day they are almost all dried and covered with a flight cruft. The inflammation of thefe pox is very fmall, and their contents do not feem to be owing to fuppuration, as in the imall-pox, but rather to what is extravafated under the cuticle by the ferous veffels of the fkin, as in a common blifter. No wonder, therefore, that this liquor appears fo foon as on the ad day; and that, upon the cuticle being broken, it is prefent ly fucceeded by a flight fcab; hence too, as the true fkinfo little affected, no mark or fcar is likely to be left, unless in one or two pox, where, either by being accidentally much fretted, or by fome extraordinary sharpness of the contents, a little ulcer is formed in the skin. The patients scarce fuffer any thing throughout the whole progrefs of this illness, except fome languidnefs of ftrength, fpirits, and appetite; all which is probably owing to confinement in their chambers. Two children were taken ill of the chicken-pox. Upon the 8th or 9th day after they were at their height in the children, the mother fell ill of this diftemper. In this inftance the infection lay in the body much about the fame time that it does in the fmall-pox. Remedies are not likely to be much wanted in a difeafe, which in fo fhort a time is certainly cured of itfelf. The prizeipal marks by which the chicken-pox may be diftinguished from the fmall-pox are, 1. The appearance, on the ad or 3d day from the eruption, of that veficle full of ferum upon the top of the pock. 2. The cruft, which covers the pocks on the 5th day; at which time thofe of the fmallpox are not at the height of their fuppuration. Foreign medical writers hardly ever mention this diftemper; and British writers fearce mention any thing more than its name. Morton fpeaks of it, as if he fuppofed it to be a very mild genuine fmall-pox. But these two diftempers are totally different, not only on account of their different appearances, but because those who have had the ímall-pox are capable of being infected with the chicken-pox; but those who have once had the chicken-pox are not capable of having it again, though to fuch as have never had this diftemper, it seems as infectious as the fmall-pox. Dr Heberden wetted a thread in the most concocted pus-like liquor of the chicken-pox which he could find; and after making a flight incifion, it was confined upon the arm of one who had formerly had it; the little wound healed up immediately, and fhowed no figns of any infection.

650. GENUS XXX. RUBEOLA. MEASLES. Rubeola, Sauv. gen. 94. Lin. 4. Sag. 293.-Febris morbillofa, Vog. 36. Hoffm. II. 62.-Morbilli, Junch. 76,

631. Sp. I. The Regular MEASLES.-Rubeola vulgaris, Sauv. fp. 1.-Morbilli regulares, Sydenh. Sed. iv. cap. 5.Var. 1. The Anomalous MEASLES-Rubeola anomala, Sauv. fp. 2.-Morbilli anomali, Sydenh. fect. v. cap. 3.-Var. 2. The MEASLES attended with Quinfy.Var. 3. The Maastas with Putrid Diathefs of the Blood.

652. Sp. II. The VARIOLODES.-In Scotland commonly called the NIRLES.Rubeola variolodes, Sauv. fp. 3.

653. Defcription. This difeafe begins with a cold stage, which is foon followed by a hot, with the ordinary symptoms of thirft, anorexia, anxiety, ficknefs, and vomiting. Sometimes from the beginning the fever is fharp and violent; often, for the first two days, obfcure and inconfiderable, but always violent before the eruption, which happens on the 4th day. This eruptive fever, from the beginning, is always attended with hoarsenefs, a frequent hoarfe dry cough, and often with difficulty of breathing. The eye-lids are fomewhat fwelled; the eyes are a little inflamed, and pour out tears; with this there is a coryza and frequent fneezing. For the most part, a conftant drowfinefs attends the beginning of this disease. The eruption appears firft on the face, and fucceffively on the lower part of the body, in fmall red points; and foon after, a number of thefe appear in clusters, which do not arife in vifible pimples, but, by the touch, are found to be a little prominent. This is the cafe on the face; but, in other parts of the body, the prominency is hardly perceptible. On the face the eruption retains its rednefs, or has it increased for two days; but on the 3d, the vivid redness is changed to a brownish red; and in a day or two more the eruption entirely difappears, while a mealy defquamation takes place. During the whole time of the eruption, the face is fomewhat turgid, but feldom much fwelled. Sometimes,' after the eruption has appeared, the fever ceases entirely; but more commonly continues or is increased, and does not ceafe till after the defquamation. Even then the fever does not always ceafe; but, though it ceafe upon the eruption taking place, the cough often continues till after the defquamation, and fometimes much longer. In all cafes, while the fever continues, the cough alfo continues, generally with an increase of the difficulty of breathing; and both these symptoms fometimes arife to a degree of pneumonic affection. A diarrhoea alfo often comes on, and continues for fome time. Measles, even when they have not been violent, are often followed by inflammatory affections, particularly ophthalmia and phthifis. If blood be drawn from a vein in the measles, the gluten always appears separated, and lying on the furface of the craffamentum. The measles, even when violent, are moftly without any putrid tendency; but in fome cafes, fuch a tendency appears both in the courfe of the difeafe, and after it is finished.

654. Causes. The measles are occafioned by a peculiar contagion, the nature of which is not underftood; and which, like that of the small-pox, affects a perfon only once in his life.

655. Prognofs. The measles being attended with a catarrhal affection, and an inflammatory diathefis, the danger is to be apprehended chiefly from their inducing a pneumonic inflammation.

656. Cure. In measles, as in fmall-pox, the difeafe muft run a determined courfe; and therefore the practitioner's fole aim is to conduct this courfe in the easiest manner, by preventing and obviating urgent symptoms. The remedies chiefly neceffary are those which may obviate and diminish

the

the inflammatory diathefis. Blood-letting may be employed at any time in the courfe of the difeafe, according to the urgency of the fever, cough, and dyfpnoea. But as the symptoms of pneumonic inflammation feldom come on during the eruptive fever, and as this is fometimes violent immediately before the eruption, though a fufficiently mild disease be to follow, bleeding is feldom neceffary. In all cafes where there are no marks of putrefcency, bleeding is the remedy moft to be depended upon, along with cooling purgatives, and bliftering between the fhoulders. The dry cough may be alleviated by demulcent pectorals, mucilaginous, oily, or fweet. For quieting the cough, opiates prove the most effectual means. While the cough and watchfulness are the urgent symptoms, they may be exhibited with great advantage. When the defquamation of the measles is finished, many phyficians purge the patient to draw off what have been called the dregs of the measles, or the morbific matter supposed to remain in the body. Dr Cullen does not reject this fuppofition; but though purging may be a proper remedy, bleeding, in proportion to the inflammatory symptoms, is ftill more fo. From the use of cold air in the eruptive fever of the fmall-pox, fome have been of opinion that it may be useful in the measles. As external heat may be very hurtful, the body ought to be kept in a moderate temperature during the whole courfe of the difeafe; but how far cold air may be applied with fafety, is ftill uncertain; for though the analogy with the fmall-pox might lead to the application of cold air during the eruptive fever of the meafles, the analogy with catarrh seems to be againft the practice. When the eruption is upon the fkin, there are many inftances of cold air making it disappear, and thereby producing much diforder in the fyftem; and there are alfo inftances of this diforder being removed by restoring the heat of the body, and thereby again bringing out the eruption.

657. Upwards of 30 years ago inoculation for the measles was propofed, and practifed in feveral inftances with fuccefs, by Dr HOME of Edinburgh. His method of communicating the infection was by applying to an incifion in each arm cotton moistened with the blood of a patient labouring under the measles; but with others the attempt has often failed, and the practice is now fcarce ever heard of.

658. GENUS XXXI. The MILIARY FEVER.Miliaria, Lin. 7-Miliaris, Sauv. gen. 95. Sag. gen. 295.-Febris miliaris, Fog. 37.-F. purpurata rubra et alba miliaris, Hoffm. II. 68.-F. purpurea, feu miliaris, Junck. 75.-Germanis der Friefel. God. Welfch, Hift. Med. de novo puerperarum morbo, qui der Friefel dicitur, Lipf. 1655.Hamilton de febr. miliar. 1710. Fantonus de febr. mil. 1747. Allioni de miliar. 1758. Fordyce de febr. mil. 1748. Fifcher de febr. mil. 1767. De Haen de divif. febr. 1760, et in Ration. med. paffim. Matt. Collin ad Baldinger, de miliar. 1764. Miliaris benigna, Sauv. fp. 1.-M. maligna, fp. 2.-M. recidivanes, fp. 3.-M. Germanica, fp. 5.-M. Boia, fp. a.-M. Britannica, fp. i.-M. nova febris, Sydenh. Sched. monit. Sauv. fp. d. -M. fudatoria, Sauv. fp.e.-M. nautica, fp. g.

M. purpurata, fp. h.-M. lactea, fp. c.-M. puerperarum, fp. k.-M. fcorbutica, fp. I.—M. critica, fp. l.

659. Hiftory and Defcription. This disease is faid to have been unknown to the ancients; that it ap peared firft in Saxony about the middle of the 17th century; and that it has fince spread through Eu rope. From the time it was first taken notice of, it has been described by many different writers; and by all of them, till lately, has been confidered as a peculiar idiopathic difeafe. It comes on with a cold ftage, which is often confiderable. The hot ftage which follows is attended with great anxiety and frequent fighing. The heat of the body becomes great, and foon produces profufe fweating, preceded, however, with a sense of prick. ing, as of pin-points in the fkin; and the fweat is of a peculiar rank and difagreeable odour. The eruption appears fooner or later in different perfons, but at no fixed period. It seldom appears upon the face, but firft upon the neck and breaft, and thence often spreads over the whole body. The miliary eruption is of two kinds, viz. the red and the white. The former, in English named a rush, is commonly allowed to be fymptomatic; and as the latter is the only one that can be confidered as idiopathic, we need only describe and treat of it. It first appears like the red, in very fmall red pimples, for the moft part distinct, but fometimes clustered. Their little prominence is better diftinguished by the finger than by the eye. Soon after their appearance, at least on the fecond day, a fmall veficle appears upon the top of the pimples, at firft whey-coloured, but it foon becomes white, and ftands out like a little globule on the top of the pimple. In two or three days, thefe globules break, or are rubbed off; and are fucceeded by fmall crufts, which foon after fall of in fmall fcales. While one fet of pimples take this course, another set arise to run the fame; to that the disease often continues upon the skin for many days together. Sometimes, when one crop of this eruption has disappeared, another, after fome interval, is produced. And fome perfons have been affected with it feveral times in the courfe of their lives. This disease is faid to affect both fexes, and perfons of all ages and conftitu tions; but especially, and most frequently, lying. in women. It has often proved fatal. The fymp toms, however, are very various; and they all occafionally attend febrile diseases; but none are fteadily the fame in different perfons, fo as to give a specific character to the difeafe. When it i violent, the most common symptoms are phrenetic comatofe, and convulfive affections.

660. Dr CULLEN does not think this was a new difeafe, when it was firft confidered as tuch There are clear traces of it in authors who wres long before that period. The antecedent fyriptoms of anxiety, fighing, and pricking of the thin are common to many other difeafes. Of the curcomitant fymptoms, there are none constant but that of fweating, which a ways precedes and alcompanies the eruption. While the miliary craption attends many different difeafes, it never ap pears but after fweating; and in perfons labouring under the fame difeafes it does not appear, it fweating be avoided. The eruption is therefore

probably the effect of fweating, and of a matter not before prevailing in the mafs of blood, but generated under particular circumstances in the kin itself; as it comes upon thofe places chiefly which are closely covered; and can be brought out upon particular places by external applications. This eruptive disease differs from the other exanthemata in the following circumftances: It is not contagious, and therefore never epidemic; the eruption appears at no determined period; it has no determined duration; fucceffive eruptions often appear in the course of the fame fever, and fuch eruptions recur in the courfe of the fame perfon's life. All this renders it probable, that the morbific matter is not a fubfifting Contagion communicated to the blood, but occafionally produced in the skin by fweating. And while the miliary eruption has no fymptoms, or Concourfe of fymptoms, peculiar to tfelf, it occaMonally accompanies almost every febrile difeafe, whether inflammatory or putrid, if thefe be attended with sweating; whence it may be prefumed that it is a fymptomatic affection only. But as this affection does not accompany every cafe of fweating, it is proper to inquire what circumtances determine this eruption to appear. To this Dr Cullen gives no complete anfwer; but obferves, that perfons fweating, under febrile difeafes, are tipecially liable to this eruption, who have been previously weakened by large evacuations, particularly of blood. This explains why it happens to lying-in women oftener than to others; and he has obferved, that the eruption has happened to other women, though not in child-bed, but who had been fubject to a frequent and copious mentrustion, and to an almoft conftant fluor albus. He alfo obferved it upon men in fevers, after wounds attended with great lofs of blood. That this eruption is produced by a certain ftate of debility, is, he thinks, probable, from its so often attending putrid fevers. It alfo fometimes attends thofe inflamma tory difeafes in which the fweats have been long protracted, or often repeated, and which have thereby produced a debility, or a debilitating putrid diathefis. As, however, the miliary eruption is not neceffarily or even generally connected with a certain state of debility, as is evident from its being entirely wanting in the greater number of typhoid fevers, and other difeafes where every poffible degree of debility occurs, it is much more probable, that it depends on fome peculiar ftate of the ferface, induced by the concurring influence of Certain predifpofing and occafional causes.

661. Cure. It appears fo clearly that this eruption is always a fymptomatic and factitious affection, that Dr Cullen is perfuaded it may be, in at cafes, prevented merely by avoiding fweats. Spontaneous fweatings, in the beginning of diftales, are very rarely critical; all fweatings not endently critical fhould be prevented, or at least oderated. Even critical fweats fhould hardly be encouraged. If, therefore, fpontaneous sweats arife, they are to be checked by the coolness of e chamber: by the lightnefs and loofenefs of the bed-clothes; by the perfon's taking cold drink: and in this way Dr Cullen thinks he has frequentprevented miliary eruptions, which were other afe likely to have appeared, particularly in puer. VOL. XIV, PART I.

peral women. But it may happen, when these precautions have been neglected, that a miliary eruption does actually appear. Dr Cullen is perfuaded, that the old practice of covering up the body closely, and encouraging the sweatings which accompany this eruption, was highly pernicious, and commonly fatal. He therefore thinks, that in all cafes in which the sweating is not manifeftly critical, we should employ all the means of stopping the fweating mentioned above; and he fometimes obferved, that even the admiffion of cool air was useful. At the fame time, the remedies fuited to the primary disease are to be employed; and therefore, when the eruption accom. panies inflammatory affections, and the fulness and hardness of the pulse or other symptoms show an inflammatory ftate, the cafe is to be treated by blood-letting, purging, and other antiphlogistic remedies. Upon the other hand, when the miliary eruption attends diseases, in which debility and putrefcency prevail, it will be proper to avoid, all evacuations, and to employ tonic and antifeptic remedies, particularly the Peruvian bark, cold drink, and cold air. The moft diftreffing circumftance in this affection is the almoft unfupportable fickness which often occurs, and precedes fresh eruptions during the disease. To counteract and alleviate this fymptom, recourfe is had to wine and other cordials. But with many patients nothing has fo much influence as camphor, given gradually in fmall dofes, under the form of the mistura camphorata of the London pharmacopoeia, or of the emulfio camphorata of that of Edinburgh.

662. GENUS XXXII. SCARLATINA. SCARLET FEVER.-Scarlatina, Sauv. gen. 98. Vog. 39. Sag. 294. Junck. 75.

663. Sp. I. The Mild SCARLET FEVER.-Scar latina febris, Sauv. fp. 1. Sydenham, fect. vi. cap. 2. 664. Sp. II. The SCARLET FEVER with Ulcerated Sore Throat.-Scarlatina anginofa. Withering on the Scarlet Fever.

665. The mild fcarlet fever, Sydenham fays, can fcarce be accounted a difeafe; as nothing" more feems to be neceffary in the treatment of it than an antiphlogiftic regimen, avoiding the application of cold air and cold drink. It however fometimes rages epidemically, and is attended with very alarming iymptoms, bearing no fmall refemblance to the cynanche maligna, in which cafe it is called fcarlatina anginofa.--The beft defcription of it was published by DR WITHERING in 1778. It appeared at Birmingham and the neighbourhood in May 1778. It continued in all its force to the end of October; but varying in fome fymptoms, as the air grew colder. In the beginning of November it was rarely met with; but towards the middle of that month, when the air became warmer, it increased again, and in fome measure refumed thofe appearances it poffeffed in fummer, but which it had loft during the cold winds in October. It affected children more than adults; but feldom occurred in the former under two years of age, or in the latter above 50.

666. Defcription. With general symptoms of fever, the patient at firft complains of a dejection of fpirits, a flight forenefs or stiffness in the neck, with a ftraitnefs in the mufcles of the neck and

Pp

fhoulders,