SECT. VIII.—ON EXANTHEMATA.
Exanthemata are formed by thick humours impacted in the skin, and more especially if the cuticle be thick. In these cases, then, even if the humours are deep-seated, they must be first purged away; for unless you do this in the first place, before attempting to dispel them, you will only impact them the more firmly, instead of evacuating them by the skin. But if the deep-seated parts be free from crudities, you may evacuate the humours by the skin, and not produce revulsion of them to a distance, which is the case, if you attempt to evacuate them by the belly or emetics. But the cure of humours fixed in the skin, is to be accomplished by fomentations and calefacients, more especially when the exanthemata happen to be broad, for these are formed by a cold and thick humour. Wherefore, take of the tender leaves of bay, of manna, and of rue equal parts, triturate together, and dissolving frankincense in honey, anoint with it; or, having boiled and pounded tender beet, apply as a cataplasm; or, take of wax, dr. viij; of sulphur the same quantity; of salt, dr. vj; triturate them dry, and having poured on them half a cyathus of oil, boil all together, and use the plaster that is formed. But one must attentively sit by while the boiling is going on. It is a very excellent medicine.
Commentary. See Hippocrates (Epidem. et alibi); Galen (Meth. Med. v); Alexander (i, 5); Oribasius (Synops. vii, 7); Morb. Curat. (iii, 21); Aëtius (v, 129); Actuarius (Meth. Med. ii, 11; i, 23); Celsus (v, 28); Pseudo-Dioscor. (Euporist. i, 106); Haly Abbas (Theor. viii, 17; Pract. iv, 8).
As stated in another place, the Greeks used the term exanthema in a much laxer signification than it is applied in Dr. Willan’s ‘System of Cutaneous Diseases.’ Hippocrates in particular may be mentioned as applying it to various classes of these affections. Alexander describes the exanthemata of the head as superficial ulcerations, which are red and rough. Does he allude to porrigo? He recommends for the cure of them a composition of litharge, ceruse, alum, the green leaves of rue, vinegar, and myrtle oil.
Galen says that exanthemata is a term applied by some to all ulcerative and rough affections of the skin, which, according to Archigenes, stand in need of desiccative applications. In another place he mentions the exanthemata as a common symptom of the plague. Aëtius in like manner gives from Herodotus an interesting account of fevers which are accompanied with exanthemata. Both have been supposed to allude to the smallpox, but we agree with Dr. Willan, that this interpretation of their descriptions is altogether fanciful.
Our author follows Oribasius closely.
According to Actuarius exanthemata, properly speaking, are produced by thick humours either formed in the skin or in the whole body, and being detained by the density of the epidermis.
Celsus describes the exanthemata under the generic term pustulæ. His words are: “Earum plura genera sunt. Nam modo circa totum corpus partemve asperitudo quædam fit, similis iis pustulis, quæ ex urticâ, vel ex sudore nascuntur: ἐξανθήματα Græci vocant. Eæque modo rubent, modo colorem cutis non excedunt.” For pustules of all kinds he recommends exercise, restricted diet, and abstinence from all things of an acrid and attenuant nature, which regimen is likewise to be enforced upon the nurse, if the child be at the breast. If the patient be strong, he is also to be put into the hot bath, and rubbed with natron and a mixture of wine and oil. If this treatment does not succeed lentils are to be applied, especially if the pustules be large; and after the outer skin has been removed they are to be treated with gentle applications. Such is the plan of cure recommended by the great Roman authority. His directions respecting the diet are particularly important, and appear to be quite in accordance with the practice of the modern physicians, who recommend the half-starving system in all such complaints.
For red exanthemata the Pseudo-Dioscorides recommends ceruse with oil of bays and sulphur, pure bark with wax, &c.
The exanthemata are described by the name of pustulæ parvæ in most of the translations of the Arabians. The exanthemata is, we think, the first species of Serie described by Haly Abbas.
For the opinions of Alsaharavius and Haly Abbas about the exanthemata of infancy, see [Book i, 6].
Dr. Willan thinks that the nettle-rash was comprehended under the term exanthemata. He is also of opinion that the benat noctis of Avicenna is the nettle-rash. It would appear, however, that the benat noctis was the same as the sera or epinyctis. See Rhases (Cont. xxxvi, 2). The symptoms of it are said to be itching, roughness of the skin, and small eruptions attacking the patient during the night.
Thucydides, Hippocrates, and Galen mention exanthemata as a common symptom of the plague.
We may take the present occasion to mention that none of the Greek or Latin authorities has given any distinct account of purpura. Avicenna has briefly described it in its chronic form. (iv, 3, 1, 8).