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first considered as such. There appear to me very clear traces of it in authors who wrote long before that period; and, though there were not, we know that the descriptions of the ancients were inaccurate and imperfect, particularly with respect to cutaneous affections; while we know also very well, that those affections which usually appeared as symptomatic only, were commonly neglected, or confounded together under a general appellation.
723. The antecedent symptoms of anxiety, sighing, and pricking of the skin, which have been spoken of as peculiar to this disease, are, however, common to many others; and, perhaps to all those in which sweatings are forced out by a warm regimen.
Of the symptoms said to be concomitant of this eruption, there are none which can be said to be constant and peculiar but that of sweating. This, indeed, always precedes and accompanies the eruption; and, while the miliary eruption attends many different diseases, it never, however, appears in any of these, but after sweating; and, in persons labouring under these diseases, it does not appear, if sweating be avoided. It is therefore probable, that the eruption is the effect of sweating ; and that it is the produce of a matter not before prevailing in the mass of blood, but generated, under particular circumstances, in the skin itself. That it depends upon particular circumstances of the skin appears further from hence, that the eruption seldom or never appears upon the face, although it affects the whole of the body besides; that it comes upon those places especially which are more closely covered; and that it can be brought out upon particular parts by external applications.
724. It is to be observed, that this eruptive discase differs from the other exanthemata in many circumstances; in its not being contagious, and therefore never epidemic; that the eruption appears at no determined period of the disease, that the eruption has no determined duration; that successive eruptions frequently appear in the course of the same fever; and that such eruptions frequently recur in the course of the same person's life..
All these circumstances render it extremely pro.. bable, that, in the miliary fever, the morbific matter is not a subsisting contagion communicated to the blood, and thence, in consequence of fever and assimilation, thrown out upon the surface of the body; but a matter occasionally produced in the skin itself by sweating,
725. This conclusion is further rendered probable from hence, that, while the miliary eruption has no peculiar symptoms, or concourse of symptoms, belonging to it; yet, upon occasion, it ac. companies almost all febrile diseases, whether in
flammatory or putrid, if these happen to be attend ed with sweating; and from thence it may be presumed, that the miliary eruption is a symptomatic affection only, produced in the manner we have
726. But, as this symptomatic affection does not always accompany every instance of sweating, it may be proper to inquire, what are the circumstances which especially determine this eruption to appear? To this, however, I can give no full and proper answer. I cannot say that there is any one circumstance which in all cases gives occasion to this eruption ; . nor can I say what different causes may, in different cases, give occasion to it.' There is only one observation I can offer to the purpose of this inquiry; and it is, that, of the persons sweating under febrile diseases, those are especially liable to the miliary eruption, who have been previously weakened by large evacuations, particularly of blood. This will explain why it happens to lying-in women more frequently than to any other persons; and to confirm this explanation, I have remarked, that the eruption' happened to womeri not in childbed, but who had been much subjected to a frequent and copious menstruation, and to an almost constant fluor albus. I have also had occasion to observe it happened to men in fevers, after wounds from which they had suffered a great loss of blood. VOL. I.
Further, that this eruption is produced by a cer: tain state of debility, will appear probable, from its often occurring in fevers of the putrid kind, which are always attended with great debility. It is true, that it also sometimes attends inflammatory diseases, when it cannot be accounted for in the same manner ; but I believe it will be found to attend especially those inflammatory diseases in which the sweats have been long protracted, or frequently repeated, and which have thereby produced a debility, and perhaps a debilitating putrid diathesis.
727. It appears so clearly to me that this eruption is always a symptomatic and factitious affection, that I am persuaded it may be in most cases prevented merely by avoiding sweats. Spontaneous sweatings, in the beginning of diseases, are very rarely critical ; all sweatings, not evidently critical, should be prevented; and the promoting them, by increasing external heat, is commonly very pernicious. Even critical sweats should hard. ly be encouraged by such means. If, therefore, spontaneous sweats arise, they are to be checked by the coolness of the chamber; by the lightness and looseness of the bed-clothes ; by the persons laying out their hands and arms, and by their taking cold drink; and, by these precautions, I think I have frequently prevented miliary eruptions, which were otherwise likely to have appeared, par. ucularly in lying-in women.
528. But it may happen, when these precautions have been neglected, or from other circumstances, that a miliary eruption does actually appear; and the question will then be put, how the case is to be treated ? It is a question of consequence, because I believe that the matter here generated is often of a virulent kind; it is frequently the offspring of putrescency; and, when treated by increasing the external heat of the body, it seems to acquire a yirulence which produces those symptoms mentioned in 719, and proves certainly fatal.
It has been an unhappy opinion with most phya. sicians, that eruptive diseases were ready to be hurt by cold, and that it was, therefore, necessary, to cover up the body very closely, so as thereby to increase the external heat. We now know that this is a mistaken opinion; that increasing the external heat of the body is very generally mischiev. ous; and that several eruptions not only admit, but require the application of cold air. We are now persuaded, that the practice which formerly prevailed, in the case of miliary eruptions, of covering up the body close, and both by external means and internal remedies, encouraging the sweatings which accompany this eruption, was highly pernicious, and commonly fatal. I am there. fore of opinion, even when a miliary eruption has appeared, that in all cases where the sweating is not manifestly critical, we should employ all the several means of stopping it that are mentioned