and fomentations or poultices to the perinæum may be resorted to. But, until these and the foregoing means fail, the introduction of instruments should not be attempted. When recourse to these is required, the able advice given by the surgical writers referred to in the Bibliography should be adopted. issue may occur before the abscess makes for itself an exit, owing to the retention of urine produced by it, and to consequent excrementitious plethora, causing fatal coma or apoplexy. This, however, will rarely occur when the patient receives medical aid. If the abscess opens into the urethra or rectum, the infiltration of excrementitious fluids through the orifice will rapidly aggravate the symptoms and accelerate the result. When the matter is ear-ternal, discharge for the matter, in order to prely evacuated per perinæum, recovery may be expected, if other circumstances be favourable or the disease be uncomplicated, no serious disease of the kidneys or bladder being associated with it. 15. B. The Prognosis of Chronic inflammation and enlargement of the prostate gland is always unfavourable. When the patient is not very far advanced in age, and the constitution is otherwise not materially impaired, then the enlargement and hardening may sometimes be reduced, especially when the disease has not been of very long duration. But in advanced age, in weakened constitutions, and when the disease is associated with inflammation or structural lesions of the bladder or of the kidneys, little hope of recovery can be entertained, although life may be prolonged for a considerable time, if the complication be not of a very severe and dangerous nature, by careful treatment and regimen. Mr. COULSON observes, that "tumefactions of the prostate which are brought on by strictures, disappear when these are cured; it is necessary, therefore, to distinguish them from more permanent disease." 16. v. COMPLICATIONS. -Acute as well as chronic prostatitis, with more or less enlargement of the gland, is not infrequently associated with one or other of the following affections: with the gravelly, especially the phosphatic diathesis; with calculous concretions in the bladder or kidneys; with irritable, inflammatory, and thickened states of the bladder; with hemorrhoids or prolapsus ani; with gonorrhoea or gleet; or with stricture of the urethra. In the more chronic states of inflammatory action of this gland, and especially when the enlargement and induration are considerable, one or other, or even more than one of these complications, is often observed. 18. B. If suppuration has commenced, Sir B. BRODIE and Mr. COULSON advise an early ex vent it bursting into the urethra. The early and free puncture of the perinæum down to the gland, save where little or no matter has yet formed, is generally useful, by the loss of blood, and the removal of the tension of the parts. If the disease have anticipated the operator, and the abscess have opened into the rectum or urethra, then the general health should be maintained. If it have burst into the latter canal, then a flexible catheter ought to be retained in the bladder, and such other means as the peculiarities of the case may require, aided by surgical assistance, ought to be adopted. 19. C. Chronic inflammation and enlargement of the prostate require at first small but repeated local depletions from the perinæum; abstinence from venereal indulgences; rest in the horizontal posture, and sleeping on a hair mattress; a farinaceous and vegetable diet, with cooling and demulcent diluents, and a gently open state of the bowels, procured by means of cooling aperients, as the confection of senna with magnesia, or bi-tartrate of potash, or with sulphur. These means will be often of service, if persevered in for some time. If these fail, emollient injections, with henbane or sirup of poppies; or suppositories with henbane or hemlock; or the local applications of ointments containing the iodide of potassium, as advised by Mr. STAFFORD; and the internal administration of the iodide of potassium with liquor potassæ in camphor-water, or in mucilaginous or demulcent fluids, or with sarsaparilla; or the tincture of the sesquichloride of iron, taken in the infusion of calumba or of quassia, when the disease is associated with the phosphatic diathesis, or the hydrochlorate of ammonia in gradually increased doses, may severally prove of some service. Blisters and issues to the perinæum, mercurial ointments, camphorated and volatile liniments, 17. vi. TREATMENT.A. In acute prostatitis, anodyne, and narcotic suppositories, have likebefore symptoms of suppuration appear, the wise been recommended. The judicious emtreatment should be strictly antiphlogistic, and ployment of these may either prevent the acconsist of the application of leeches, or of cup- cession of, or relieve, or even remove, retenping over the perinæum; of cooling diaphoret- tion of urine. But when these fail, recourse ics, especially the liquor antimonii tartarizati, to surgical aid ought not to be delayed; and with liquor ammoniæ acetatis and spiritus æthe- for opinions as to the employment of surgical ris nitrici, in camphor water; of DOVER's pow-means, I refer the reader to the works enumeder at bedtime; of cooling saline aperients, and rated below. cooling lavement in the morning; and of farinaceous or vegetable diet. If there be much heat about the anus, a frequent injection of a cold fluid and cooling lotions to the perinæum and anus will be of use. And, in such cases more especially, the patient should recline on a horse-hair sofa, or sit upon an open cane-bot-vous irritation, causing disorder of, or obstruction tomed chair. The patient's beverages should be diluent and demulcent, and all stimulating and heating food and drink ought to be avoided. If retention of urine be threatened, owing to the swelling of the gland or of the middle lobe, and if cold enemata and cold lotions have failed, the hip-bath, demulcent and soothing clysters, II. ORGANIC LESIONS OF THE PROSTATE GLAND. DEFIN. Changes of structure of the prostate gland, of various kinds, resulting generally from prolonged vascular excitement, or functional or ner to, the urinary excretion, and often associated with other affections of the urinary organs and rectum. 20. i. The most frequent ORGANIC LESIONS Of this gland are ENLARGEMENT and INDURATION, consequent upon chronic inflammation.-a. But these changes may take place independently of any actual inflammatory action, frequent func tional excitement consequent upon entertain- | scrofulous absorbent gland. Mr. GUTHRIE has ing prurient ideas, or upon frequently practiced met with a case in which the enlargement self-pollutions or other venereal excesses, often caused by scrofulous deposites or suppuration occasioning these lesions independently, as well of the prostate was remarkably great. It is as in consequence of inflammatory action, ei- probable that these scrofulous changes are ther acute or chronic. There is every reason, merely the results of sub-acute or chronic inmoreover, to infer that sexual desires and fre- flammation of the gland, occurring in scrofulous quent excitement of the genitals are attended subjects, and giving rise to the formation of by more or less active congestion of the pros. scrofulous pus, in the form either of small detate, with or without increased prostate secre- posites or of larger collections, which become tion, which, if continued habitually for a long more or less altered by the absorption of their period, will pass into enlargement and indura- more watery parts, or by the occurrence of contion, and often occasion obstruction to the ex- secutive irritation and softening. cretion of urine. M. VELPEAU notices, by the appellation of "Catarrh of the prostate," an increased flow of the prostatic secretion, arising from prolonged gonorrhoea or gleet, or frequent attacks of these, and appearing chiefly when the patient has been to stool or has passed his urine. Although sometimes supervening upon inflammatory states of the urethra, this morbidly increased secretion is more frequent after habitual self-pollutions and sexual excitement, and is attended by congestion or active determination of blood to the gland with more or less enlargement, and with several of the symptoms of prostatitis in a slight degree. 21. b. Swelling or enlargement of the gland from a varicose state of the vessels, mentioned by CHELIUS, is merely a form of congestive or noninflammatory enlargement. It generally occurs slowly in old persons, after venereal excesses, after repeated attacks of gonorrhoea or gleet, after hemorrhoidal complaints and constipated bowels, and after abuses of stimulating liquors. It is met with most commonly in the sedentary and those who live richly; the difficulty of emptying the bladder increasing, and becoming great, especially after violent exertion, and after heating food and drink. The swollen prostate is felt per rectum, but it is free from pain, and there is no pain in the passage of urine through, the urethra. "The varicosity is situated rather in the coverings of the prostate. The substance of the gland itself is sometimes soft and spongy, sometimes tense and hard." 24. Mr. WILSON states that scrofulous swellings of the prostate are usually found in persons not advanced beyond the middle period of life; that they are slow in their progress, and not attended by much pain; that they may be felt per anum; and that their effects upon the excretion of urine depend upon the size and form they assume. 25. b. The treatment of scrofulous enlargements of the prostate consists chiefly in the use of the iodide of potassium with liquor potassæ and sarsaparilla of sea-water, or of cold water with salt dissolved in it, topically, and occasionally as a clyster; of sea-bathing and sea-air; and of the application of an ointment of the iodide of potassium to the gland in the manner recommended and explained by Mr. STAFFORD, 26. iii. ULCERATION OF THE PROSTATE is sometimes observed.-a. It rarely occurs in the anal aspect or surface of the gland, unless as a consequence of the extension of ulceration, or of cancer of the rectum. It is not infrequently seen in the urethral surface of the gland, sometimes near the bladder, but oftener near to or on the verumontanum itself. Ulceration is a consequence generally of scrofulous disease of the prostate, or of purulent formations, or of injuries occasioned by bougies or catheters. 27. b. The diagnosis of ulceration of the prostate is very obscure. The appearance of blood on a bougie, or after micturition; the existence of pain in the situation of the gland, and the acute exacerbation of pain upon the passage of a bougie, and upon micturition, will suggest the probable existence of ulceration, but by no means prove it; inasmuch as these symptoms attend inflammation of either the prostate it 22. c. The treatment of these states of enlargement of the prostate depends much upon the evidence of their source. If they be consequent upon congestion or active determination to the organ, and if the constitution be not re-self, or of the prostatic portion of the urethra. markably impaired, local depletions should be prescribed. Clysters of cold water, or of the decoction of oak-bark, with alum; attentive regulation of the bowels; and a cautious use of the catheter, with the other means suggested for the removal of the chronic states of prostatitis (§ 18, 19). titis, are generally of service (§ 19). 23. i TUBERCULAR DEPOSITES IN THE PROSTATE, and small puriform collections disseminated through the gland, are mentioned by M. VELPEAU as having been, in rare instances, observed by him, and attended by more or less swelling. They may go on to ulceration or abscess, and terminate in fistulous communications with the urethra or rectum.-4. Dr. BAILLIE has also observed scrofulous disease of this gland, as, upon dividing it, a white curdy matter has been found in it; and scrofulous pus has been forced out of its ducts. Mr. WILSON states that he has seen the prostate enlarged and changed into a white curdy matter, precisely the same in quality as that formed in a 28. c. The treatment which these symptoms suggest will depend upon, and vary with the circumstances of the case, but it will not be materially different from what has been recommended above for the consequences of prosta 29. iv. HEMORRHAGE FROM THE PROSTATE may Occur from ulceration, from the opening made by an abscess, from the accidental rupture of vessels, or from injury by a catheter. In these the hemorrhage is rarely very great, and the blood passes by the urethra; but when it is excessive, it may flow into the bladder, where its presence, especially its coagula, always occasions distress. In a case published by Mr. COPLAND HUTCHISON, the bladder was suddenly filled with blood, which proceeded from "two fungoid tumours which projected into this viscus from the prostate gland." The bladder was perfectly healthy. The entrance of the urethra was situated between the two tumours; the left being about the size of a hen's egg, and 30. V. FUNGO-ENCEPHALOID DISEASE AND CANCER have been met with in the prostate.-A. In the former, either the fungoid or the encephaloid structure may predominate. This form of malignant disease may be primary and solitary, .as in an interesting case recorded by Mr. STAFFORD; or it may be a part only of a more general manifestation of this malady. the other that of a walnut. (Lond. Med. Repos., | carbonate or the phosphate of lime, with a large vol. xxii., p. 130.) The treatment of hemorrhage proportion of animal matter. 2d. Calculi may from the prostate does not differ from that ad- form in the ducts and cavities of the gland convised for hemorrhage from the urinary passages.secutively of stricture of the urethra, owing to (See art. HEMORRHAGE, ◊ 215.) the passage into and stagnation of urine within these parts, as shown above; and may afterward increase so as to be partially external to the gland; in this case they may be similar, in chemical constitution, to other urinary calculi, according to the existing calculous diathesis, and may reach a large size. 3d. They may originate in the first of these modes, and subsequently increase greatly in size, owing to urinary deposite, as in the second mode. 4th. Fragments of calculi may escape into dilated prostatic ducts or cavities after lithotomy, or small gravelly calculi may pass into the ducts independently of this operation, where they may increase, as in the second mode of formation. 31. B. Carcinoma, or scirrho-cancer, of this gland is rarely seen; but the prostate may be implicated in scirrhus, or cancer of the rectum. It is rare that scirrhus of the prostate occurs primarily, or in an uncomplicated form. Sir B. BRODIE, however, has adduced cases in which scirrhus appears to have affected this gland primarily. 34. The first or true prostatic calculi vary in 32. C. When fungo-encephaloid malignant size from that of a pin's head to that of a pea, disease is seated in the prostate, there is not and in number from eight, ten, or twelve to only great enlargement and retention of urine, forty or fifty. They are often attended by little but also an elastic or soft tumour felt per anum, inconvenience until they obstruct the excretion sometimes with hemorrhage from the urethra, of urine; but, in rare instances, they occasion following efforts to pass urine. A scirrhous distressing irritation and excitement. Two restate of the gland is indicated by acute inter-markable cases of prostatic calculi are reported mitting pains in the prostatic region, uncon- by Dr. HERBERT BARKER (Trans. of Provin. Med. nected with the excretion of urine, and enlarge-and Surg. Assoc., N. S., vol. ii.), and by Proment with a stony hardness of the prostate felt per anum, in addition to the usual symptoms of chronic enlargement. fessor FERGUSSON (Lond. Med. Gaz., Jan. 7, 1848). The calculous deposite was most probably formed, in these cases, in the second of the 33. vi. CALCULI IN THE PROSTATE.-The cal-modes now pointed out. Indeed, Professor culi found in the cavities of the prostate have FERGUSSON mentioned to me, that this was the been too generally viewed as quite different probable mode of their formation in the case from those formed in the bladder, and as being operated upon by him, as they were preceded altogether similar to those concretions some-by stricture of the urethra. Dr. PROUT believes times found in the salivary ducts and elsewhere. that the larger calculi, which are smooth and It is not improbable that, while there are some polished, and have a porcelain-like appearance, which thus originate, there are others which always originate in abscess of the prostate, but are formed chiefly from urinary deposites; or it will be found that they are formed in the which, originating in the gland itself, become cavities of the prostate consecutively of stricgreatly enlarged by urinary deposites, the pros-ture of the urethra, as shown above. tatic calculi being only the nuclei around which 35. Dr. CROSSE, of Norwich, remarks, that these deposites are formed. It should be recol-"it is only when large or numerous in one large lected that, when there is obstruction to the cyst, or projecting into the urethra, that prospassage of urine through the urethra, owing to tatic concretions give rise to the symptoms of stricture, the prostate gland is then sometimes stone; frequent painful micturition, and disseen with its follicular cavities very much wid-charge of mucus from inflammation of the ureened, and its ducts dilated; the latter being thra and neck of the bladder. They seem to be even as much enlarged as to admit of the intro-sufficiently often combined with stone in the duction of a crow-quill. When, therefore, the bladder to lead us to suspect that the one disurine is prevented from passing by stricture, or ease contributes to the production of the other; passes only in small quantity, some of it is and, indeed, I consider that urinary calculi, forced into the ducts and cavities of the gland, stricture of the urethra, or whatever other diswhich thereby become enlarged, the muscular eases here situated, causing inflammation of coat of the bladder being also gradually thick- the prostatic part of the urethra, and interruptened. In these circumstances, if prostatic cal-ing the free exit of the excretion of the prostaculi exist, they will readily increase, owing to tic ducts, dispose to the formation of calculi of the passage of urine over them, or the stagna- this description." These observations, by so tion of it around them; but when the ducts learned and experienced a surgeon, show the and cavity become thus dilated, and admit the connexion I have contended for; while his suburine during efforts to expel it, the calculi may sequent remarks indicate that the third mode in actually form in the prostate from the urine which I have viewed the forination of those calthus propelled into and accumulated in the cavi- culi (33) is one to which he most justly atties of the gland. I consider that calculi may taches great importance, although he generalform in the prostate, or be found either alto-izes more in respect of them than agrees with gether or partly in it, as follows: 1st. They my views. "A distinction to be kept in mind may form in the gland, or in its ducts, inde-in respect of prostatic calculi is," Dr. CROSSE pendently of any access of the urine, or deposite from this excretion; and in this case they are small and numerous, consisting chiefly of the observes, "that they are not urinary concretions, but are formed and may increase without the urine having access to them; they may, notwithsanding, rise to the orifice of the prostatic ducts, or get into, or be detained in the urethra, or pass retrograde into the bladder, becoming the nuclei around which deposites from the urine take place." This is one of the modes of formation which I have enumerated, and I could not have an abler authority upon which I might found my views. 36. B. The Diagnosis of prostatic calculi is seldom very clear, unless the calculi are large or numerous, or project into the urethra or bladder. Mr. COULSON justly observes, that "a retention of urine or pain about the neck of the bladder, and frequent desire to make water, are sometimes the only symptoms; and these are common to several other affections of the prostate gland urethra." Per anum the gland may be felt to be enlarged; and, in some instances, the calculi may, by their number, form, or size, furnish sufficient evidence of their presence, as in a case mentioned by Dr. MARCET, where they could be plainly felt through the coats of the rectum. When the calculi project from the gland into the urethra, the sound will strike against it; but it will still be a question whether or no the calculus be one which has passed out of the bladder into the urethra. The history of the case, and the existence previously and at the time of symptoms referable to the prostate, will be the chief guides to a diagnosis. When they strike or grate against an instrument, they will occasion sensations in both the prostate and perinæum, and in the glans penis, which will indicate their nature. When very large or numerous, they may be felt, as if in a cyst, per anum, or they may protrude so as to be felt in the perinæum. 37. C. Treatment.-When severe symptoms are produced by prostatic calculi, then dysury, stricture, sacculi, inflammation, and thickening of the coats of the bladder all ensue; and in extreme cases, and when it is fully ascertained, upon the requisite examinations, that large or numerous prostatic calculi are present, it will be right, as advised by Dr. CROSSE, to cut down to the prostatic gland from the perinæum, as in the lateral method of litho-cystotomy, and to remove the concretions. An interesting case, recorded by Mr. COULSON (Op. cit., p. 273), will farther illustrate the treatment, which is entirely surgical; and to this, as well as to the remarks of other eminent writers noticed in the Bibliography, I must refer the reader. sions of the prostatic gland are those already noticed (§ 16), especially inflammation and thickening of the coats of the bladder; structural lesions of the kidneys, strictures of the urethra, gleets, and gonorrhea; involuntary pollutions; the several diseases of the rectum, particularly hemorrhoids, prolapsus ani, stricture, or scirrhus; constipation and various affections of the colon, hemorrhage from the urinary bladder, or from the urethra, or from the rectum, and intestinal worms. BIBLIOG. AND REFER.-P. J. Desault, Œuvres Chirurg., 8vo. Paris, 1803, t. iii., p. 220.-E. Home, On Dis. of the Prostate Gland, 2 vols. 8vo. Lond., 1811-18.-J. Howship, Observ. on Dis. of the Urinary Organs, 8vo. Lond., 1816. -J. Shaw, On Structure of Prost. Gland; in C. Bell's Surg. Lond,, 1816.-E. A. Lloyd, On Observat., vol. i., 8vo. Scrofula, 8vo. Lond., 1821, p. 107.-J. Howship, On Complaints affecting the Secretion and Excretion of Urine, 8vo. Lond., 1823.-J. Wilson, On the Male Urinary and Genital Organs, 8vo. Lond., 1821.-T. F. Meckel, Tabulæ Anatomico-Pathologicæ, fasc. ii., tab. 13.-A. Cooper, Lectures in Lancet, 1823 and 1824.-W. Lawrence, Lectures in ibid., 1829 and 1830.-Amussat, Leçons sur les Rétentions d'Urine et sur les Mal. de la Glande Prostate, 8vo. Paris, 1838.Cruveilhier, Anatomie Pathologique, t. i., fol. Paris, 1835, liv. xviii.-B. C. Brodie, On the Diseases of the Urinary Organs, 3d edit., 8vo. Lond., 1842, p. 143.—J. G. Crosse, On the Formation, Constituents, and Extraction of Urinary Calculus, 4to. Lond., 1835, passim.-S. Cooper, Dict. of Practical Surgery, 7th edit., p. 1117.-J. A. Mercier, in Archives générales de Méd., 3d series, t. v., p. 209.-G. E. Verdier, Observat. et Reflex. sur les Phlegmasies de la Prostate, Svo. Paris, 1838.-Leroy d'Etioles, Considerations Anatom. et Chirurg. sur la Prostate, 8vo. Paris, 1840. Vidal, Ann. de Chirurg. Franc. 1841, t. ii., p. 31. -Velpeau, Dict. de Médecine, art. Prostate.-W. Coulson, On the Diseases of the Bladder and Prostate Gland, 3d ed., the Treatment of some Diseases of the Prostate Gland, Svo. 8vo. Lond., 1842, p. 239.-R. A. Stafford, An Essay on Lond., 1845.-J. M. Chelius, A System of Surgery. Transl. by J. F. South, 8vo. Lond., 1847, vol. ii., p. 421. PRURIGO. SYNON. Cnesmos (xvnoμòs, Galen); Pruritus, Scabies papuliformis, Auct. Exormia Prurigo, Good. Das Jucken, jeukte, Germ. CLASSIF 6th Class, 3d Order (Good). 1st 1. DEFIN.-An eruption of papula, larger than those of lichen, not materially differing from the colour of the skin; attended by excessive heat and pungent itching; becoming covered with small black scabs when scratched or abraded; leaving behind them yellowish stains; very chronic in duration, but not contagious, and generally unattended by fever. 2. This eruption generally appears about the neck and shoulders, and sometimes extends to the face, trunk, and limbs, more especially to 38. vii. CONCRETIONS FORMED IN THE VEINS, the back; and to the outer sides of the arms about the prostate gland and neck of the bladder, and thighs, in the line of extension, and ashave been noticed by MECKEL, TIEDEMANN, sumes a severe character. It is occasionally OTTO, LOBSTEIN, and CROSSE. The last-named confined to a single spot. Its mildest forms author states, that "in aged persons, particu- may decline in the course of three or four larly with hypertrophy of the prostate, a blad-weeks; but much more frequently it continues der diseased, and the veins about it and the rectum varicose, concretions of phosphate of lime or carbonate of lime, varying in size from a pin's head to a kidney-bean, are often found in the veins." Sometimes they present the appearance of a white pea, and an inequality or projection answering to the part by which they adhered to the vessel. These concretions have no connection with urinary or other excretions, and are merely growths or concretions which had been adherent to the coats of the vein. They approach nearer to ossific than to calculous concretions. (CROSSE, Op. cit., passim.) 39. viii. THE COMPLICATIONS of organic le several months, or even years, and is attended by a burning and intolerable itching. WILLAN has distinguished three varieties, which may be modified in certain localities, or be limited to these localities, thus assuming three local forms. The varieties, according to WILLAN and other writers, are Prurigo mitis, P. formicans, and P. senilis. The first and second differ from each other merely in degree, there being no fundamental distinction between them. The third variety has some peculiar characters. 3. I. DESCRIPTION.-i. Prurigo mitis appears in the form of small and slightly prominent papulæ, broader than those of lichen, soft and smooth to the touch, and of the same colour as 5. iii. Prurigo senilis, or Senile prurigo, closethe skin. They are attended by incessant itch-ly resemble prurigo formicans; but the papulæ ing, which is greatly increased upon the re- are harder, larger, and more confluent. It is moval of the clothes, by changes of tempera- attended by incessant and insupportable itchture, by the warmth of bed, and by exercise. ing, and may endure for years, with varying When left to themselves, or not aggravated by severity. The papulæ are intermingled with scratching, or by a heating regimen, they sub- small black scabs and numerous scratches, causside, with a slight exfoliation of the epidermis; ed by attempts to relieve the pruritus. In more but more commonly the relief of the pruritus at- prolonged cases the skin becomes swollen, intempted by scratching causes the removal of flamed, and as if thickened; and the affection the tops of the papula, which then become cov- is sometimes complicated with eruptions of vesered by a small characteristic black scab, form-icles, pustules, or boils, according to the coned by the drying of a minute exudation of blood stitution and regimen of the patient. Abscesson the abraded spot. If the papulæ be much es are even occasionally formed. But these irritated, ecthymatous pustules are sometimes external associations generally proceed from developed. This form of the eruption is most more or less marked disorder of the assimilafrequent in the spring and summer months in ting and excreting functions, more especially the situations above mentioned (2). It is of the liver, bowels, and kidneys, with or withoften preceded by slight disorder of the digest-out gastro-intestinal irritation or febrile exciteive and excreting functions, especially of the latter, and occasionally by slight acceleration of pulse; but these are usually overlooked. The mildest cases may terminate in about three weeks; but more frequently fresh papulæ appear as the preceding vanish, and the eruption may thus be prolonged for several months. ment. 6. In a severe case of senile prurigo, WILLAN found a number of minute pulices upon the skin, and he remarked the frequent association of the pediculus vestimentorum with this eruption. In very old persons, or in the debilitated, when the eruption follows febrile diseases, and in those who live on poor, unwholesome food, but especially in debilitated persons in the decline of life, swarms of pediculi not infrequently complicate this affection. There is, however, also more or less disorder of the abdominal functions, with either a poor or impure state of the circulating fluids. 4. ii. Prurigo formicans is merely a severer form of the preceding. The papulæ are, however, generally larger-broader and more prominent, yet flat. They are distinct, nearly of the colour of the skin, if not torn by the nails, and commonly seated on the neck, back, loins, and external aspect of the limbs, although they may appear also on other parts. They are 7. iv. Local Forms.-These are merely the sometimes very numerous in young subjects. occurrence or limitation of prurigo-of its charThe itching is more severe and pungent than acteristic eruption, to certain localities, where in the first variety, resembles the gnawing of it usually becomes severe and prolonged, and innumerable ants or the pricking of hot nee- occasionally produces additional annoyance or dles, and is increased towards evening by the distress. In the several localities constituting heat of bed, and by the circumstances already these forms, the eruption is similar to some one noticed. RAYER remarks, that patients descri- of the varieties already described; the locality bing their feelings liken them to burning fires favouring no one variety more than another.— and maddening itchings. ALIBERT says that A. Prurigo podicis is generally an eruption of PLATO, CHARLES V., CHARLES IX., and other papulæ similar to those of P. mitis, but more great men, were afflicted with this eruption; frequently to those of P. formicans around the and that the Abbé MORELLET, at the age of anus, sometimes extending to the perinæum, eighty, expressed himself as writhing on "St. between the nates and thighs. The symptoms LAWRENCE's gridiron" when suffering from it. and duration of the eruption are the same as The warmth of bed sometimes increases the stated above. After its long continuance the itching to such a pitch as to cause the patients skin around the anus becomes rough, thickento scratch themselves until they bleed, and as ed, and otherwise altered.-B. Prurigo scroti to prevent sleep until morning, or until exhaus- is merely the extension of the eruption to the tion sinks them into it; when they often soon scrotum, and is not farther peculiar in any reawake to be similarly tormented. The black spect, the symptoms and sufferings being the scabs following the scratching are frequently same as in the several varieties.-C. Prurigo the chief appearance of eruption, although red-pudendalis is seated chiefly in the labia majora ness of the skin is often produced for a short time by the scratching. The affection continues for months, and, with varying remissions or intermissions, often for years, especially in weak children and adults, and in old persons. After the subsidence of the eruption the skin remains dry and thickened, and the epidermis exfoliates. This form of the complaint is generally preceded by disorder of the abdominal organs, and by slight fever, which tend to complicate and perpetuate it. Like numerous other cutaneous affections, it should be viewed as a local manifestation of disorder implicating the excreting functions and the state of the circulating fluids, and requiring a treatment directed accordingly. It may occur in both children and adults at any period of the year. and mucous surface of the vulva. It is attended by constant but varying pruritus, occasioning swelling or inflammation of the parts, sometimes with a serous exudation; and it induces sexual excitement and self-pollution, amounting in some instances to nymphomania. This form sometimes occurs during pregnancy, and occasions much misery. 8. II. DIAGNOSIS.-Prurigo is distinguished by the absence of colour from the papulæ, and by the stinging or burning pruritus. It may, however, be confounded with lichen and some of the vesicular eruptions.—(a) It is distinguished from lichen by the larger size of the papulæ, by the small black scabs, and by the intense burning itching.-(b) Prurigo is most likely to be confounded with scabies, but the papula of |