Herpes mentagra. The division of herpetic eruptions according to their external form is of little consequence, as they are remarkably changeable. 789. It is uncertain whether the proximate cause of herpetic eruptions consists in a specific dyscrasy, whether it be the same in all herpetic diseases, or whether upon its difference depends the peculiar form of the herpes. Some kinds, especially the eating kind, cannot in its advanced degree be denied to be contagious.

The disposition to herpes which may also be hereditary, depends commonly on a peculiar delicacy and sensibility of the skin, in which usually Herpes furfuraceus consists; the herpes mostly shows itself in those parts which are very sensible and are much exposed to the air, therefore especially on the face and hands. The remote causes are frequently stoppages in the intestines of the belly, especially faulty action of the liver, suppression of the natural or long-continued discharges, hæmorrhoids, sweating of the feet, the monthly purification and the like, diminished secretion of the skin and kidneys especially in elderly persons, previous acute eruptions of the skin or acute diseases especially. Further, uncleanliness, neglected cleansing of the skin, irritation of the skin from rough, especially from woollen clothing, or from working among wool; the use of very acrid food and drink. This herpes is often complicated with scrofulous, syphilitic, or gouty affections, and these seem to be its especial causes; although they can be less distinguished by the peculiar form of the eruption and ulcer, than by the general symptoms belonging to them. In hot climates herpes is more frequent than in cold; in our region it is more especially developed in summer; in the winter it often subsides entirely or remains stationary.

From what has been said, it is clear why the repulsion, or imperfect development of herpes, may bring about dangerous symptoms, inflammation and pain in the internal parts, spasms, convulsions, apoplexy, palsy, sudden death, stoppage in the bowels, dropsy, consumption, and so on.

VEIEL (a) has proposed a division of herpes, which is extremely important, both as regards the generic development and the treatment. According to his views, herpetic eruptions are either direct effluvia from the blood or diseased changes of the several organs of the skin. They are in part hereditary, derived from ancestors, and deeply rooted in the organism; in part acquired—that is, are the spontaneous crises of various diseases, as gout, rheumatism, and so on, or diseases consequent on acute and contagious exanthemata, as scarlet fever, itch, and so on.

The blood-herpetic eruptions are primarily produced by an apparently fluid deposit beneath or on the skin, as the reflection of disturbance in the mixing of the blood, as the immediate effluvia from the extremities of the blood-vessels. The herpetic eruptions of the skin are secondary changes of the structure of the layers of the skin, produced first of all, by a disease of the actual organ of the skin, in which either the blood selects this organ as a depôt, or in which it is spontaneously diseased. The blood-herpes is usually hereditary, shows itself in the development of the teeth as Strophulus and obstinate Porrigo; before puberty commonly as scrofula, especially as scrofulous ophthalmia; after it, as herpes, and finally as gout. The skin-herpes mostly acquired, occur as consequent of other eruptions, porrigo, itch, nettle rash; the blood-herpes, especially Eczema chronicum and Porrigo, from checking of the perspiration, from the mode of living, and so on. Blood-herpes is variable; it subsides and appears without discernible cause, and spreads suddenly; it prefers the vascular and richly glandular parts of the body, and selects bladders or pustules as its special form. The skin-herpes spreads constantly and obstinately, prefers the extending sides of the joint, and presents itself in scales and imperfect.

The blood-herpes, as a semicritical result of deficient mixing of the blood, repelled by external remedies, may produce dangerous consequences from metastasis, whilst skin

(4) Ansichten über Flechten in Allgemeinen; in CASPER'S Wochenschrift für die ges. Heilkunde, May, 1842.

herpes, cured by external remedies, has no such dangerous consequences. The relapse of blood herpes commonly arises without any distinguishable cause or disease, especially after influenza; that of skin herpes after want of food, suspension of perspiration, after rheumatic fever, and so on. Blood-herpes depends, 1, on the quantitative misproportion of the blood: a, with excess of albumen, the moist herpes, Eczema chronican, in which a group of capillary vessels pour out serum, whereby the cuticle is raised into bladders which seem to be grouped; b, with excess of fibrin the pustular herpes, Impetigo, in which serum containing fibrin is poured from the vessels of the corion into the tissue, whereby single, cellular pustules are produced: in milk-crust there is only modification from the child's age; c, with excess of salts of the blood, the salt flux, Eczema impetiginoides pedum, in which salt serum is poured forth from the veins of the skin beneath it, which reddens, destroys it, and only on the edges forms distinct vesicles; d, with excess of serum, chronic vesicular eruption, Pemphigus, chronic nettle rash, chronic tetters, in which an effusion of water in the cells of the corion form the tubercles or papules of lichen, the tooth-rash, Strophulus: 2, on qualitative mispro portion; a, from itch complicated with Eczema, Prurigo, or Scabies spuria, in which not groups of vessels, but only single twigs pour out serum and form distinct, scarcely perceptible vesicles beneath the cuticle; b, from the poison of Tinea, complicated with Impetigo, Porrigo adultorum mucosa, little pustules on the skin of the head. Skin-herpes depends-1, on disease of the glands which form the skin: a, there is only a diseased scaly cuticle secreted, without the participation of the dermal tissue in the disease; little herpetic eruptions, Pityriasis, Icthyosis, and Squammositas cutis; b, an unnatural scale of skin may be deposited on the diseased corion; a dry scaly-herpes, Psoriasis; c, a deposit of unnatural scales on the diseased corion, and diseased under skin, and cellular tissue in a circular eruption, Lepra; if the cellular tissue be not merely inflamed but degenerated, it is Elephantiasis: 2, from disease of the perspiratory glands, Miliaria chronica: 3, from disease of the sebacious glands, Acne : 4, from disease of the roots of the hair, Sycosis: 5, from disease of the subcutaneous cellular tissue; a, this gradually shrinks, thereby affects the glands of the skin, so that the cuticle exfoliates in a diseased state, finally the corion is destroyed, and the entire spot sinks in, becomes smooth, glossy, transparent, forms on the edge little vesicles connected with the subcuticular cellular tissue, which ulcerate superficially; superficial eating herpes, superficial Lupus; b, the subcutaneous cellular tissue supperates, produces tubercles and pustules, which freely burst through the cuticle, supparating deep-eating herpes, Lupus ulceratus; c, single and, subsequently, confluent tubercles which raise the corion and cuticle, the Lupus hypertrophicus.

790. The cure of herpetic ulcers first requires the removal of the cause. In stoppage of the bowels, laxative and opening remedies are to be given; in diminished secretion from the skin and kidneys it must be endeavoured to reproduce them; in scrofulous, syphilitic, or any other complication, the treatment will direct the contrary; as the mode of living changes if it be in causal relation to the herpes, the mode of living must be especially regulated, in most cases less animal and more vegetable food, but in others more strengthening though always simple diet must be prescribed.

In general the following medicines are anti-herpetic:-antimony, mercury, sulphar alone, or connected with the other; æthiops antimonialis, æthiops mineralis, calomel with sulphur auratum, graphit (a), iodine, cod-liver oil; further, drinks operating on the skin and kidneys, especially if the secretion of urine be sparing or dropsical accumulations have been already produced; decoction of dulcamara, of various kinds of woods, the ola tricolor, lign. juniperi, cortex mezerei, tinctura cantharidis, and the like. If the skin be very much inflamed, flowers of sulphur, with cream of tartar and guiaicum.

791. The external treatment, which especially requires attention, and in all cases in which the herpes depends on internal causes, only after previous internal treatment, must be directed by the condition of the ulcers. If these be inflamed and painful, merely lukewarm water and mild salves or fomentations are to be employed. When the inflamma(a) WEINHOLD, K. A., der Graphit, oder neuentdecktes Heilmittel wider die Flechten. Meissen, 1832. 8vo.

tion has diminished, sulphur baths, solution of sublimate, the phagedenic water, red or white precipitate ointment, flowers of sulphur, with fat or with soap and water, mercurial ointment, unguentum citrinum, oxygenatum, graphit salve, a solution of nitrate of silver, and the like are to be used; in old herpetic eruptions the douche with sulphur water, or a blister upon the part of the eruption to destroy it completely, which may be effected by often touching with nitrate of silver. Sulphur with soap and water made up into a liniment and a solution of sublimate I have found more effectual than all other remedies. In this treatment derivation with issues or setons and strict dietetic regimen is always necessary. If symptoms arise from metastasis of the herpes, it must be reproduced as quickly as possible. In habitual herpes, where frequently all remedies are employed in vain, bathing of the part on which the herpes is situated in a decoction of almond bran is very serviceable. In very deep-rooted and wide spread herpetic eruption, when the skin is much changed, the sublimate baths (a), the hunger-cure, and ZITTMANN's decoction are very efficient. In such cases, arsenic internally and externally is recommended. The Herpes exedens on the face is often alone cured by completely destroying the diseased part with caustic, and best by HELLMUND'S remedy (b).

B.-OF SCALLED HEAD.

FRANK, J. P., Epitome de curandis hominum morbis, book iv. p. 87.
GALLOT, L. S., Dissert. sur la Teigne. Paris, 1802.

ALIBERT, above cited, first book.

792. Under the term Scalled Head (Tinea (c) Capitis, Lat.; Kopfgrind, Germ.; Teigne, Fr.) are included the ulcers situated in the skin of the hairy part of the head, covered with crusts of various thickness and colour and accompanied with a secretion of an often peculiarly smelling ichor. Previous to the formation of these ulcers, there occurs a more or less severe smarting, redness and often swelling on some part of the head not unfrequently accompanied with swelling of the glands in the neck and headache. These symptoms increase and then among the hairs are observed sometimes pustules or vesicles, surrounded with an inflamed edge, sometimes circumscribed, pea-shaped swellings, which are white and yellowish at their tip. When these burst an ichorous fluid pours out, mats the hair together, and when it dries forms crusts, beneath which the ichor collects, the skin is destroyed; considerable pain and swelling of the glands of the neck are produced; and usually many lice are generated.

793. According to the different forms of scalled head are distinguished: 1. Tinea favosa. From the little pustules are produced by drying up of the matter contained in them yellowish crusts, often isolated and round, often by running together of considerable extent, with their centre indented, their edges raised, and accompanied with painful itching and secretion of ichor, having the smell of cat's urine. When of long standing all the ulcerated places are covered with thick white crusts, which stick fast, and the intervening skin is covered with branny scales. The ichor collects

(a) v. WEDEKIND; in HUFELAND'S Journal, 1822. August.

(b) RUST's Magazin, vol. xix pt. i. p. 55.

(c) BATEMAN and the modern English writers prefer the genuine term Porrigo used by CELSUS to Tinea proposed by SAUVAGES.

between these crusts, and frequently destroys the skin even to the bone. Similar crusts are often formed on the face and other parts. If the crusts be removed, the skin is found inflamed, and a clammy fluid exudes from it. 2. Tinea granulata.-This is characterized by small, tubercular, irregular crusts, sometimes gray, sometimes grayish, without depression at their tip, usually situated on the upper hinder part of the head, surrounded with branlike scales, and accompanied with a nauseous secretion having the smell of rancid butter or putrid milk. These tubercles, not deeply penetrating in the skin, cause painful smarting, spread very rarely upon some parts of the face, but never on other parts.

3. Tinea furfuracea.-Upon the hairy part of the head are formed branny, whitish, more or less thick scales, which are sometimes quite dry, sometimes accompanied with a secretion of a filthy smelling, viscous fluid, and with painful itching. They spread frequently on the forehead, and eyebrows.

4. Tinea asbestina.-Commonly upon the fore and upper part of the head, scales are produced, silvery white, glossy, resembling asbestos, which mat the hair together, and cover its whole length, but are accompanied with little pain, and scarcely any secretion.

5. Tinea muciflua.-Pustules or little abscesses arise, pouring out when they burst a yellowish viscous fluid, which dries into whitish yellow crusts. A mucoid fluid, resembling spoiled honey, flows out in quantity and mats the hair together. These ulcerations generally spread over the whole face. 794. If the scalled head be of long continuance, or have been neglected, it often produces considerable destruction of the skin of the head, loss of the hair, disturbance of nutrition, suspension of the development of the body, diseased changes of the nails and the like. In Tinea muciflua there is often general falling away when the secretion diminishes, and the previous good health only returns when it reappears.

795. Scalled head occurs usually in children about ten years old; but the Tinea muciflua commonly shows itself during lactation. Scalled head, however, often also occurs later, especially Tinea favosa; but Tinea asbestina is peculiar to adults.

The proximate cause of scalled head is an inflammation of the skin, on which the diseased secretion depends, and by the drying up of the secreted fluid the crusts are produced. The occasional causes may be, in children the too great flow of blood to the head, too nourishing food, milk from a debauched, diseased wet nurse, uncleanliness, living in bad damp air, irritation of the head from lice, and its too warm covering; also scrofulous or syphilitic dyscrasies, and contagion, which, though not always, may under certain circumstances occur.

796. Scalled head is in many cases to be considered as a healthy discharge, and its sudden suppression dangerous. The difficulty of curing it depends on the variety of its causes. If it be easily removable, frequently a simple local treatment is sufficient for its cure; but if it depend on a scrofulous or syphilitic dyscrasy its cure is always difficult. It often first subsides at the period of puberty.

797. The treatment of scalled head is as various as its causes. The diet must, therefore, often be changed; attention paid to fresh air and exercise; special cleanliness observed; slightly aperient, diluent remedies, especially purifying the skin, and in scrofulous and syphilitic dyscrasies their antidotes are recommended.

798. The local treatment must lessen the irritation, loosen the crusts, and cleanse the sores. This must be effected by frequent washing of the head with softening decoctions, by rubbing in mild salves, fresh butter, sulphur-flowers and hog's lard, by softening poultices of mallows and hemlock. This treatment, with at the same time cleaning the head with combing, or cutting off the matted hair and removing the lice. If the ulcers be obstinate, sulphur ointment must be used, or a solution of sublimate employed. This local, with internal treatment, corresponding to the general state of the patient, and a properly regulated diet, has up to the present answered to my wishes in all cases. Other remedies that have been recommended are, solution of sublimate with verdigris, solution of liver of sulphur, decoction of tobacco, red and white precipitate ointment, unguentum oxygenatum, ægyptiacum, citrinum, solution of sulphate of potash with lime water, soap and spirits of wine, and so on. In very obstinate cases, according to ASTRUC and others, a plaster of gum ammoniacum and vinegar, thickly spread on leather, and applied for six or eight weeks, will effect the cure. The pulling out the hairs with forceps, or with strips of sticking plaster, is rarely, and only necessary when by their irritation they keep up the sore. The sudden tearing off of a pitch plaster, applied over the whole head, and therewith the sudden removal of the hair is objectionable. When the scalled head has continued a long while, artificial sores must be produced by mezereon, issues, and so on, before the cure can be effected.

C. OF MILK-CRUST.

STRACK, C., De Crustâ lacteâ infantum, ejusdemque specifico remedio. Dissert. altera præm. ornat. Frft., 1779.

12mo.

WICHMANN'S Ideen zur Diagnostik, vol. i. p. 43.

AUTENRIETH, Versuche für die praktische Heilkunde aus den klinischen Anstalten zu Tubingen, vol. i. pt. ii.

799. Milk-crust (Crusta lactea, Tinea faciei, Lat.; Milchborke, Germ.; Croûte laiteuse, Fr.) consists in smarting spreading ulcers, which arise from little vesicles on the cheeks, ears, forehead, or chin; these burst and pour out a yellowish fluid, which dries into white or yellowish crusts. The discharge from the ulceration is sometimes trifling, sometimes considerable. The eruption spreads gradually over the whole face, with which usually inflammation of the eyes is set up, even over part of the head, the neck, and other parts, and the child wastes in consequence of the continual restlessness.

When this eruption is more moist and eating, great smarting is produced from little blisters like pimples, slightly raised above the skin, and dusky, which soon spreading on the face and other parts, form dusky crusts; and the children, from their continual uneasiness, often waste, become feverish and miserable. The disease is, in this form, called Crusta serpiginosa.

800. Crusta lactea is generally a disease void of danger, and of indefinite duration, not unfrequently subsides of itself, (in which case the urine is turbid and smells like cat's urine,) and recedes without scarring. It occurs generally in infancy, but also in children from four to seven years of age, and even later. Its causes are too copious nourishment,