ART. X. Defcription and Treatment of Cutaneous Diseases; Order 1ft. Papulous Eruptions on the Skin. By Robert Willan, M. D. F. A. S. 4to. 110 pp. 155. J. Johnson, St. Paul's Church-Yard, London. 1798. ALTHOUGH the affections or diseases of the skin form a part in all general fyftems of medicine, and moft of them have, at different times, become the fubjects of particular effays, yet they have rarely been confidered together, or their connec tions or diftinctions been clearly pointed out; neither has the advance to perfection, in the mode of treating them, kept pace with the improvements that have been made in other branches of medicine. Hence it has happened, that the management of cutaneous diseases has, in a peculiar manner, fallen to empirics and noftrum-mongers, who derive from it a large part of their revenue. Dr. Willan has attempted to fupply this deficiency. and to arrange cutaneous difeafes in a fcientific order. He begins by giving a fketch of what has been done by former writers, particularly by the Greek, Latin, and Arabian physicians; of whofe works, on the fubject, he gives a concise but clear account. In purfuance of his plan of arranging cutaneous diseases, he defines the terms he employs in defcribing the different kinds of marks or eruptions on the fkin. But as these cannot always be fo diftinctly defcribed by words, as to mark the fhades of difference which are neceffary to be known, in order to obtain clear ideas of them, elegant coloured engravings are given of each fpecies, to which the reader is perpetually referred. Thefe form the fubjects of the first plate, are fixteen in number, and are ranged in the following order: fcurf, scale, crust, scab, stigma, papula, rafh, macula, tubercle, veficle, puftule, of which five different kinds are delineated. We shall give a few of the definitions. Papula; a very fmall and acuminated elevation of the cuticle, with an inflamed bafe, not containing a fluid, not tending to fuppuration. The duration of papulæ is uncertain, but they terminate for the most part in fcurf. "Macula; a permanent difcolouration of fome portion of the fkin, eften with a change of its texture, but not connected with any diforder of the conftitution. Tubercle; a hard fuperficial tumour, circumfcribed and permanent; or proceeding very flowly to fuppuration." If the author had given under each of the definitions a reference to fome difeafe, in which that kind of eruption is moft most distinaly marked, as fmall-pox, nettle-rafh, itch, &c. it would have made them ftill more intelligible. This was the more neceffary, as the prefent publication contains only one of the claffes or orders into which he has divided cutaneous difeafes. "I proceed," the author fays, p. 16. " to arrange cutaneous difeafes in feven orders, to be characterized by the different appearances of papulæ, fcales, rafhes, veficles, puftules, tubercles, and macula. "Papule, the order treated of in this number, may be confidered as enlargements of the papille of the skin, occafioned by a determination of the blood to them, fometimes attended with a degree of inflammation. The fmall papillæ thus enlarged, elevate the cuticle immediately above them, and appear red. A flight effufion of lymph often takes place in thefe circumflances, and gives a puftular form to several of the papula; but the fluid is reabforbed without breaking the cuticle. Three kinds of papulæ are here noticed. Strophulus, lichen, and prurigo. "Strophulus (red gum, tooth eruption) is a papulous eruption peculiar to infants, and exhibiting a variety of forms, which may be defcribed under the titles of ftrophulus intertinétus, albidus, confertus, volaticus, and candidus." Three engravings of fubjects affected with varieties of this difeafe, are given to illuftrate the defcriptions. As this disease is well known, and in general requires little medical aid, we shall pass to the next divifion, lichen. This term has also been used by medical writers, to denote a great variety of diseases; the prefent author confines it to fpring eruptions, fcorbutic pimples, &c. and defines it, p. 40, "An extenfive eruption of papulæ, affecting adults, connected with internal diforder, ufually terminating in fcurf, recurrent, not contagious. The extent of the difeafe being thus limited," he adds, " I Thall proceed to defcribe the varieties of it, which have occurred to my obfervation, under the denominations of lichen fimplex, lichen agrius, lichen pilaris, lichen lividus, and lichen tropicus." The following account of the prickly heat, lichen tropicus, is felected as giving the inoft accurate defcription of that coinplaint we remember to have seen. The author received it from Dr. Winterbottom, formerly phyfician to the colony at Free-Town, Sierra Leone. "The prickly heat appears without any preceding diforder of the conftitution. It confifts of numerous papulæ, about the fize of a finall pin's head, and elevated fo as to produce a confiderable roughness of the skin. The papulæ are of a vivid red colour, and often exhibit an irregular form, two or three of them being in many places united together; but no redness or inflammation extends to the skin in the intertices of the papulæ. Y y BRIT, CRIT, VOL. XI. JUNE, 1798, * The "The eruption is diffufed over those parts of the body which are ufually covered, as the neck, breast, arms, legs, and infide of the thighs. It does not appear on the face except on the upper part of the forehead contiguous to the hair; neither is it ever found in the palms of the hands, foles of the feet, nor on the hairy fcalp.-The number of the papule is much increased by wearing flannel or clothes too warm and thick for the climate. When perfpiration is very copious, fmail pearly puftules, containing a limpid humour, are often intermixed with the prickly heat, more especially on the breast, and about the wrists: bat they terminate in fcales, having no difpofition to ulcerate, though violently fcratched. A troablefome itching attends the prickly heat, and prevents fleep. ing during the night. There is likewife a frequent fenfation of pricking, as if a number of pins was piercing the skin. This often takes place fuddenly, after drinking a difh of tea or any warm liquor, fo as to caufe the perfon affected to start from his feat. "The eruption is in general stationary, and appears equally vivid in the day, and in the night. It does not leave one part, and arife on an. other, unless the former be much exposed to cold, and the latter be heated by additional clothing, or by friction. An increase of heat indeed, in all cafes, produces a greater number of papulæ. They fometimes difappear on a fudden, and return again as fuddenly, without any obvious caufe: but whenever the eruption continues for a length of time, the papule throws off minute fcales, and are fucceeded by a fresh crop, no veftiges being left in the skin. "Perfons of a fair complexion, with red hair and a soft skin, are moft liable to this eruption, and have the greatest quantity of it. Thofe who are of a dark complexion, either remain wholly free from the eruption, or are affected with it very flightly. "As foon as fettlers are habituated to the climate, this complaint becomes lefs frequent, and troublefome; and at length entirely difappears. "The prickly heat is, in general, confidered as a falutary eruption, whence we are cautioned not to repel it from the skin by cold or other external applications. Such a repulfion cannot, however, be eafly etfected; it is certainly not produced by bathing, which has been hitherto thought highly prejudicial. A vivid eruption of the prickly heat is a proof that the perfon affected with it is in a good state of health, although its abfence does not always indicate the contrary. The fudden difappearance of it, which frequently happens, is rather an effect than a caufe of internal diforder, as of fever or any flight complaint of the ftomach in the latter cafe a temporary ftimulus applied to the fomach, as by fpirits, tea, or other warm liquids, has the power of reftoring the eruption. Its appearance on the fkin of perfons in a state of convalefcence from fevers, &c. is always a favourable fign, indicating the return of health and vigour. "Various means have been employed to alleviate the itching, and tingling of the prickly heat; the favourite remedy at Sierra Leone is the juice of lines rubbed on the fkin, which, however, has no confiderable effect. I have found it of most advantage to use a light, cool drels, and to avoid the drinking of warm liquors The "The black natives are fubject to this eruption, though in a lefs degree than Europeans. In them, the finall papulæ are of a dull white colour, and therefore lefs ftriking to the eye, than diftinguishable by the touch, from the roughnefs they produce in the fkin." Bontius, in his Treatife de Medicina Indorum, has noticed this complaint. He recommends a lotion of vinegar, water, and nitre, to alleviate the itching; and cautions against purging, even with the gentleft cathartics, which he had seen occafion dyfenteries. There are two plates, containing four figures, of parts of the arms and legs of perfons affected with different. fpecies of lichens. The third class, Prurigo (Gratelle, or univerfal itching of the skin). "The symptom of itching," the author obferves," is common in a greater or lefs degree to moft difeafes of the skin; but there are fome cafes in which it occurs as the leading circumftance, and is at the fame time accompanied with an eruption of papule, the colour of which fcarcely exceeds that of the adjoining cuticle, and with other appearances fufficiently particular to conftitute a diftinct and independent genus of difeafe. To this therefore," he adds, "I thall apply the denomination of prurigo." P. 71. Three varieties of this difeafe are noticed by Dr. Willan. The prurigo mitis, formicans, and fenilis. In these the whole furface of the fkin is ufually affected. Cafes of local prurigo are alfo frequently met with, which take their name from the parts affected. The difeafs in this clafs are, in general, difficult of cure. The author has collected all that has been advanced on the fubject, by the most celebrated writers, and added many judicious obfervations from his own practice; but for these we muft refer to the work; as well as for an ingenious account communicated by Dr. John Sims, with which the volume concludes. In an advertisement at the end of the volume, the author .obferves, "That the publication has been delayed much beyond his intention, in confequence of the difficulties experienced on a subject entirely new, by the different artists employed in completing it. These difficulties," he adds,"" being now furmounted, the work will proceed with more expedition." This intelligence announcing a more speedy completion of the work, than, from the difficulty with which it must be attended, could have been reafonably expected, will, we are certain, be received with pleafure. We have only further to obferve, that the plates are, in general, well executed, and convey tolerably Y y 2 tolerably correct ideas of the different fpecies of eruptions. We must however except from this commendation fig. 6, in the first plate, intended to reprefent papulæ. These are defined small and acuminated elevations of the cuticle, not containing a fluid; but in the engraving they appear globular and pellucid. Cadell ART. XI. An Epifle to a Friend, with other Poems. By the Author of the Pleasures of Memory. 4to. 2s. 6d. and Davies. 1798. FEW poems of the fame date have attained a more extenfive popularity than "the Pleasures of Memory." The fubject is eminently pleafing; and though the execution is not faultlefs, nor wholly exempt from the affectations of modern writing, it is fufficiently good to confer deferved celebrity on a young writer; and particularly on one whofe line of life feemed likely to lead or compel him to other contemplations. By the fuccefs of that poem, the character of the author feems to have been fixed. He writes at prefent with the caution of a man who has a stock of fame to lofe; and while he hazards no great flights, his lines are ftudiously terfe, and corrected with very laudable care. His ftudies and amufements are evidently thofe of a man who feels a right to approach the Mufes, and whofe tafte is finally determined to the best literary models, and the moft claffical performances of art. The " Epistle to a Friend" is one of those poems which will become more interefting as the celebrity of the author fhall increase; and every approved poem which Mr. Rogers may hereafter produce, will recall his admirers to this, for a picture of his mind,enjoyments, and purfuits. He invites a friend to his villa, the more remarkable parts of which he points out, and concludes with a character of himself, put into the mouth of an aged domeftic. His judgment is manifeftly improved fince the production of his former work; and there are in thefe pages but few lines or expreflions to which even a fevere critic would object. At the fame time, it must be allowed that there is little to call forth a very warm encomium. The following lines are good. "When April-verdure fprings in Grosvenor-fquare, And the furr'd beauty comes to winter there, She bids old Nature mar the plan no more, Ah, |