Some readers will not purchase without a sample, and, as we before observed, the work will not admit of any curtailment, we shall copy the author's account of Lepra, the first genus of the second order SQUAME.

"The term Lepra is here appropriated solely to the leprosy of the Greeks, as described by the more accurate of those writers. It is characterised by scaly patches, of different sizes, but having always nearly a circular form.*

"1. Lepra vulgaris, the ordinary species of the disease in this country, commences with small, round, reddish, and shining elevations of the skin, at first smooth, but within a day or two exhibiting thin white scales on their tops. These gradually, sometimes rapidly, dilate to the size of half-a-crown, still retaining their oval or circular form, and are covered with shining scales, and encircled by a dry, red, and slightly elevated border. In some cases these scales accumulate so as to form thick prominent crusts. If the scales or crusts are removed, the skin appears red and shining, being very smooth, and free from the cuticular lines in the beginning, but marked, in the advanced stages, with long deep lines and reticulations, not always coinciding with those of the adjoining surface.

"The lepra most commonly commences on the extremities, where the bones lie nearest to the surface, especially below the elbow and the knee, and usually on both arms, or both legs, at the same time. From these points it gradually extends, by the formation of new and distinct patches, along the arms or thighs, to the breast and shoulders,

"The confusion which has every where prevailed in the use of the terms lepra and leprosy, seems to have originated principally with the translators of the Arabian writers after the revival of learning. The Greeks agreed in appropriating the appellation of apa to a scaly eruption (as its etymology dictated): most of them deemed it the highest degree of scaliness, exceeding in this respect the Lichenes, Psora, and Alphos; and those who were most minute in their description, stated that it affects the skin deeply, in circular patches, at the same time throwing off scales like those of large fishes.' (See Paul. Ægin. de Re Med. lib. iv. cap. 2; and Actuarius, de Meth. Med. lib. ii. cap. 11: also Aëtius, tetrab. iv. serm. i. cap. 134; and Galen. Isagoge.) This was sufficiently clear; but those who translated the works of the Arabians into Latin, fell into the extraordinary mistake of applying the Greek term to a tubercular disease, which had been actually described by the Greeks under the appellation of Elephantiasis; and they applied the barbarous term Morphea, together with Scabies and Impetigo, to the scaly diseases of the Greeks above enumerated. Whence their followers, who detected the error, spoke of the Lepra Arabum as well as the Lepra Græcorum; while the less accurate confounded every foul cutaneous disease under the term leprosy. The Arabians themselves do not employ the word Lepra, but have described these different diseases under appropriate appellations."

and

and to the loins and sides of the abdomen. In several cases I have observed the eruption most copious and most permanent round the whole lower belly. The hands also become affected, and in many cases the hairy scalp; but the face is seldom the seat of large patches, although some scaliness occasionally appears about the outer angles of the eyes, and on the forehead and temples, extending from the roots of the hair. In the more severe cases, the nails of the fingers and toes are often much thickened, and become opaque and of a dirty yellowish hue, and are incurvated at the extremities: their sur face is also irregular, from deep longitudinal furrows, or elevated ridges.

"When the eruption of lepra is moderate in degree and extent, it is not attended with any uneasy sensations, except a slight degree of itching when the patient is heated by exercise, or becomes warm in bed; and a little occasional tingling in certain states of the atmosphere.* When it is generally diffused, however, and there is a considerable degree of inflammation in the skin, it is accompanied with extreme soreness, pain, and stiffness, which I have sometimes seen so great as to render the motions of the joints impracticable, and to confine the patient to bed. Yet even under these circumstances there is no constitutional disturbance; and if no medicine be employed, the disease of the skin may continue for months, or even years, without any material derangement of the system.

"It is not easy to point out the causes of this disease, which appear, indeed, to be very various; for it is one of the most common affections of the skin, a least in this metropolis, and occurs at all periods, and under every circumstance of life. It is certainly not communicable by contagion, nor does it appear to originate from confinement to certain kinds of diet, such as fish, dried or salted meats, &c. since it is not endemic in districts where these are habitually used, and occurs frequently where they are almost unknown. But, like some other cutaneous affections of a more transient character, it is certainly produced occasionally by the influence of particular articles of food and drink, which operate through the idiosyncrasy of individuals. I have met with one gentleman in whom spices or alcohol speedily produce it. The original attack in him occurred after eating

"Hippocrates remarks that some Lepre itch before rain: lib. Περι Χυμων.

It is difficult, therefore, to account for the opinion expressed by the late Dr. Heberden, respecting the extreme rarity of lepra in this country. De vero scorbuto et lepra, nihil habeo quod dicam, cum alter rarissimus est in urbibus, altera in Anglia pene ignota; unde factum est ut hos morbos nunquam curaverim. (Comment, cap. 23.) And still more difficult to explain the statement of Dr. Cullen, whose definition of lepra will include both the dry and humid tetters (Psoriasis and Impetigo) with the proper scaly lepra; but who never theless affirms that he had never seen the disease. Nosol, Meth. class iii. gen. 88, note.”

3 H 2

some

some hot soup, containing spice, the first spoonful of which excited a violent tingling over the whole head, which was followed by the leprous eruption, which soon extended to the limbs. In another case, in a young gentleman of nineteen, the disease commenced after taking copious draughts of cream; and vinegar, oatmeal, and other species of food, to which it has been ascribed, have probably given rise to it occasionally but these are all anomalies, and are only referable to peculiar idiosyncracy.* In some cases it has commenced after violent and continued exercise, by which the body had been much heated and fatigued.

"Dr. Willan has imputed the origin of lepra to cold and moisture, and to certain dry sordes on the skin. It has seldom occurred to me, however, to witness the disease in bakers, laboratory men, and others who work among dry powdery substances; while I have observed a considerable number of cases in young ladies, and in persons of both sexes in respectable ranks of life, by whom every attention to cleanliness was scrupulously paid. Where cold and moisture have excited the eruption of lepra, the predisposition to it must have been peculiarly great. On the whole, the causes of this disease are involved in much obscurity. There is obviously an hereditary predisposition to it in some individuals.

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2. Lepra alphoidest. This is a less severe form of the disease

than

"Some poisonous substances taken into the stomach have produced an eruption of lepra. The poison of copper is stated to have speedily excited it in several persons at the same time, in one of whom it continued for a month, but disappeared in the others in about ten days. See Med. Facts and Obs. vol. iii. p. 61.”

"The Greeks have described the Alphos as a milder disease, being more superficial, and less rough, than the lepra: (see Galen, de Sympt. Caus. lib. iii.-Aët. tetrab. iv. serm. i. cap. 134.) and the description of it given by Celsus accords with the appearances of the L. alphoides above stated. Aλpos vocatur, ubi color albus est, fere subasper, et non continuus, ut quædam quasi gutta dispersæ videantur. Interdum etiam latius, et cum quibusdam intermissionibus, serpit.' (de Medicina, lib. v. cap. 28.) Celsus no where employs the term lepra.'

"This scaly Alphos, which was deemed by Hippocrates a blemish, rather than a disease (Hap Habwy, sect. 15), was distinguished from another white affection of the skin, the Leuce, which was not scaly, but consisted of smooth shining patches, on which the hairs turned white and silky, and the skin itself, and even the muscular flesh underneath, lost its sensibility. The Leuce was a disease of an incurable nature. (Hipp. Пpopinie. lib. ii.) Celsus, although pointing out this distinction, includes the Leuce and the Alphos under the same generic title, Vitiligo. (loc. cit.)

"It may be remarked that the Arabians distinguished these two affections by different generic appellations, calling the Alphos Albohak,

and

than the preceding. It differs chiefly in the small size of the patches, which seldom extend beyond the diameter of a few lines, or become confluent,-in the minuteness and greater whiteness of the scales, and in its limitation to the extremities. This variety of lepra is most common in children. It is tedious and difficult of cure, like the former, and requires similar treatment.

"It would be superfluous to enumerate the catalogue of useless medicines which have been recommended from ancient times for the cure of lepra: I shall, therefore, confine my attention to those, of the beneficial agency of which I can speak from experience. It is necessary to premise, however, that there is no one remedy, nor any invariable plan of treatment, which will succeed in lepra, under all the circumstances of its appearance in different instances; and that great errors are committed by prescribing for the name of the disThe circumstances to which I allude more particularly, are the different degrees of cutaneous excitement, or inflammatory action which accompany the disease in different habits; and which, if carefully attended to, afford an important guide to the most successful application of remedies.

ease.

In the less irritable conditions of the leprous eruption, such as the L. alphoides usually exhibits, as well as a few cases of the L. vulgaris, a gently stimulant mode of treatment, at least externally, is requisite; though in all cases of lepra the diet should be light and moderate, and heating liquors should be avoided, especially male liquors and spirits; for every indulgence in these points will be felt in the aggravation of the symptoms. A frequent use of the warm bath, with which a moderate degree of friction may be combined, contributes to remove the scales, and to soften the skin; or, if the eruption be confined to the extremities, local ablution and friction may be sufficient. These cases are benefited by the use of the sulphur waters of Harrowgate, Leamington, Crofton, and other wellknown springs, both internally and externally, and by the warm sea-water bath. In fact, these gently-stimulant ablutions are often sufficient, if persevered in during several weeks, to remove the modifications of lepra of which I am now speaking.

"But if the scales adhere tenaciously, or are accumulated into thick crusts (see Def. 2), then some more active lotion must be con

and the Leuce Albaras, with the epithet white. Their translators have called the former Morphæa, and included the Leuce and Ele phantiasis under the appellation of Lepra. By retaining these distinctions in recollection, the accounts of the older writers may be read, -while the confusion arising from their misapplication of names may be avoided.

"It appears probable, that the Leuce was the leprosy of the Jews, described in Leviticus, chap. xiii. See Greg. Horstii Obs. Med. lib. vii. p. 330.-Leon. Fuchsii Paradox. lib. ii, cap. 16.Th. Campanellæ Ord. Medic, lib. vi. cap. 23.-Hensler, vom Abendländischen Aussatz, p. 341."

joined with the warm ablution, or with the application of steam, in order to clear the surface. Lotions of diluted alcohol, of sulphurated potass, or the decoction of dulcamara, will aid the exfoliation; and the thick crusts may be softened and loosened by lotions containing a portion of the liquor potassæ, or of the muriatic acid. When these are removed, the cuticle may be restored gradually to its healthy condition, by the unguentum picis, or the unguentum hydrargyri mitratis diluted with saturnine cerate, or simple ointment; or lotions containing a small proportion of the oxymuriate of mercury may be substituted. The ointments should be applied at night, and washed off in the morning with warm water, or a slight saponaceous lotion. "The same cases will be accelerated in their progress towards a cure, by the use of those internal remedies which tend to support the strength, and to stimulate the cutaneous vessels. For this purpose the arsenical solution,* recommended by Dr. Fowler, is often extremely beneficial, in doses of four or five drops, which may be slowly increased to eight, and persevered in for a month or more.t Pitch, administered in the form of pills, is productive of a similar good effect, where the cutaneous circulation is very inert; but both these medicines are liable to aggravate the eruption, where it is connected with much irritability of the skin. The solution of oxymuriate of mercury has appeared to have some efficacy in these inert states; and in thin and delicate girls, of relaxed habit, affected with the lepra alphoides, the vinum ferri, or the tartrite before-mentioned, has been taken with much advantage.

"One of the most effectual remedies for lepra, however, under all its varieties, is the decoction of the leaves and twigs of the solanum dulcamara, which was introduced to the notice of British practitioners by Dr. Crichton.§ This medicine is at first administered in doses of

"Preparations of this mineral have a direct tendency to stimulate the cutaneous circulation, and to inflame the skin; and are, therefore, altogether inadmissible in the irritative forms of lepra."

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This active medicine being now not only sanctioned by the profession in general, but by the Pharmacopoeia of the College, it will be enough to state, that, in these smaller doses, which experience has proved to be sufficient, it may be taken without any inconvenience. Another preparation, introduced by the late Dr. de Valangin, is kept at Apothecary's Hall, under the name of solutio solventis mineralis, and is equally efficacious in smaller doses."

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If in any case the tinct. lyttæ prove useful in lepra, it would probably be in these more inert instances. But it is to be observed that Dr. Mead, who originally recommended this medicine, was speaking, not of the scaly Lepra, but of the Leuce, or of the Elephantiasis. See his Medicina Sacra, cap. ii."

§ See his communication to Dr. Willan. (Treatise on Cutan. Diseases, p. 145.) His formula has been adopted by the College in the late edition of the Pharmacopoeia."

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