!<'4rr DELINEATIONS CUTANEOUS DISEASES EXHIBITING THE CHARACTERISTIC APPEARANCES OF THE PRINCIPAL GENERA AND SPECIES COMPRISED IN THE CLASSIFICATION OF THE LATE WILLAN; AND COMPLETING THE SERIES OF ENGRAVINGS BEGUN BY THAT AUTHOR. BY THOMAS BATEMAN, M.D. F.L.S. EIBEAEIAN OF THE MEDICAL AND CHIKUUGICAL SOCIETY OF LONDON, HONOEAKY MEMBER OF THE LITERARY AND PHILOSOPHICAL SOCIETY OF NEW YORK, AND PHYSICIAN TO THE PUBLIC DISPENSARY, AND TO THE LONDON HOUSE OF RECOVERY. LONDON: PRINTED FOR LONGMAN, HURST, REES, ORME, AND BROWN, PATERNOSTER-ROW. 1817. T. Davison, Lombard-street, Whitefriars, Loudon. PREFACE. i 2 ii*' S'l-v In pathology, as well as in other departments of science, the advantages of methodical arrangement and a definite nomenclature, in aiding the progress of inquiry, have been generally acknowledged; but no branch of nosology appears to be so necessary or amenable to practical utility, as the classification of those diseases, which, being external, exhibit palpable differences of character, and are subject, like other objects of natural history, to the examination of our senses. From this circum¬ stance alone, cutaneous diseases are, therefore, peculiarly capable of illustration by nosological arrangement; and, in fact, nothing but the want of such an arrangement can account for the general confusion of language and indiscriminate practice which have heretofore prevailed in this branch of medicine. Among the various attempts which have from time to time been made to class these diseases, the method pro¬ posed by Professor Plenck has alone any pretensions to accuracy. It is founded upon the proper basis of external character; and, indeed, appears to have been the model adopted by Dr. Willan for his own classification: but it was not followed out in its various parts with the same correct adherence to the fundamental principles, nor supported by the same extensive practical observation, the same perspicuity of diagnosis, and the same clear detail of symptoms belonging to each PREFACE. ]V genus and species. Hence it was not calculated, like the more correct S3'^stem devised by Dr. Willan, to fulfil all the purposes of nosological investigation. There is another circumstance, however, which renders the diseases of the skin equally capable of methodical classification with the other objects of natural history, namely, the facility of representing them b^^ drawings. This was first attempted by Dr. AVillan, and the engravings annexed to his work contributed greatly to the elucidation both of the general principles of the classification and nomenclature, and of the forms and progressive changes of various species of cutaneous disease. It was a source of considerable regret and disappointment, therefore, to the profession, that this work, and especially its excellent illustrations, should have been but half completed by its lamented author. Many intimations of this feeling reached me soon after the publication of my Synopsis, in consequence of its acknowledged deficiency in respect to the plates, which should have accompanied the work as completed by the hands of its author. The publication of the whole system in a compendious and accessible form has, however, probably been the means of diffusing a knowledge of it through a much wider field, and thus, I trust, of contributing to extend this part of pathology beyond the limits which it would have reached under the more costl}^ form in which it originally appeared. For I have the satisfaction to state, that within the space of three years four large impressions of the Synopsis have been called for; and that it has been translated into the French and German languages, (into the latter under the direction and with the annotations of the learned Professor Sprengel,) and republished in America. In order, however, to fulfil the wishes of the profession by the completion, as far as it was in ray power, of the series of engravings PREFACE. begun by Dr. Willan, I have purchased the copy-right of that work, together with the drawings and engravings procured by him, and have now brought that series to a conclusion. It remains for me to say a few words respecting the mode in which this has been accomplished. The first four Orders, Papula, Squama, Exanthemata, and Bulla, have been illustrated by the reprinting of Dr. ‘Willan's engravings, improved by Mr. Stewart, with the following ex¬ ceptions. Plate XII, representing the Psoriasis gyrata, was re-engraved. In Plate XIII, which is new, a very accurate portrait of P. inveterata is substituted for Dr. WillaiTs confused and indistinct representation of that disease; and another variety of P. diffusa is supcradded. Plates XVIIl and XXX are also new: the former, exhibiting the disease Ich¬ thyosis when it affects the face; and the latter, a variety of Purpura unnoticed bj'' Dr. AYillan. The second figure was added to Plate XXXII, from a drawing left by Dr. AVillan, illustrating a species of Erythema, which he had omitted to represent. With Plate XXXIV the new series of engravings commences; and the superiority of exe¬ cution by the able hand of Mr. Stewart will be very evident through the remainder of the series, Avith the exception of Plates XLVIII, LXIII, LXVII, and LXIX, Avhich Avere already rather coarsely en¬ graved by another artist for Dr. AVillan. I think it but justice to Mr. StcAvart to point out this circumstance. AVith the exception of the representations of Impetigo, Porrigo, Ecthyma cachecticum. Varicella (P. XLVI), Herpes praputialis, Rupia, Eczema impetiginodes, ^ mer- curiale, the carbuncle of the plague. Vitiligo, Molluscum contagiosum. Sycosis barha, and Elephantiasis, all the iieAv engravings AA^ere made from draAvings found in Dr. Willafrs collection, Avith their names Avritten by his OAvn hand, and obviously intended to illustrate his Avork, had he PREFACE. vi lived to complete it. I stated, in the advertisement prefixed to the first Fasciculus of this work, some reasons for omitting the engravings re¬ presenting those varieties of the different genera, which were reputed syphilitic. Further observation has confirmed the propriety of that omission: for the subject has been rather perplexed than elucidated by the most recent experiments; and it would be presumptuous, in the present state of our knowledge, to attempt to determine the character of the eruptions of true syphilis. 14, Bloomsbury-sqmre, Oct. 1st, I 817 . T. B. INDEX. Acne, simplex —— punctata -indurata - rosacea Ecthyma vulgare -luridum ' ■ cachecticum Eczema solare -impetiginodes — - - rubrum -mercuriale Elephantiasis Ephelis Erythema marginatum -papulatum -tuberculatum - - - nodosum Herpes phlyctsenodes -zoster -circinatus -prseputialis Ichthyosis simplex -cruris -faciei Impetigo figurata -sparsa -scabida Lepra vulgaris -alphoides —— nigricans Plate. LXII. LXIII. LXIV. XLIII. XLIV. LVI. LV. LVII. LVIII. LXVIII. LXIX. XXXII. XXXI. XXXII. XLIX. L. LI. LII. XVI. XVII. XVIII. XXXIV. XXXV. XXXVI. VII. VIII. Lichen simplex -pilaris -circumscriptus contagiosum Nsevus Pityriasis capitis -versicolor Plague, Carbuncle of the Pompholyx diutinus -pruriginosus Porrigo larvalis - furfurans - scutulata -decalvans -favosa IV. : V. S LXVII. LV. 1 . LX. ] LXI. LXX. LXXI-II. XV. ] LIX. 1- XXXIII. XXXVII. XXXVIII. XXXIX. . XL. XLI. XLII. Prurigo mitis -formicans -senilis Psoriasis guttata -diffusa -, other varieties -gyrata -inveterata -palmaria Purpura simplex VI. X, XI, XIII. 1 XII. XIII. 2 XIV. XXVIII. 1 INDEX. Purpura haemorrhagica —--urticans -senilis Roseola aestiva - autumnalis - annulata - infantilis - variolosa - vaccina Rubeola vulgaris ——— sine catarrho -nigra Rupia simplex -prominens Scabies lymphatica Plate. XXVIII. XXIX. XXX. XXV. XXVII. 1—2 Scabies purulenta -porcina Scarlatina simplex -anginosa Strophulus intertinctus -albidus -confertus -volaticus -Candidas Sycosis menti -capillitii Varicella Vitiligo Urticaria febrilis -evanida Plate. Fig. XLVl. 1 XXII. XXIII. II. III. 1 — 2 — 3 LXV. LXVI. XLVII, XLVIII. LX. 2 XXIV. 2 'i'F" V- ; ' >"4»' li EXPLANATION OP THE PLATES. This Fasciculus contains a representation of the principal species of the first Order of Cutaneous Eruptions, which are characterized by PAPULiE or Pimples The three genera of this Order are Strophulus, Lie hex, and Prurigo. PLATE I. The Strophulus mtertinctus; popularly termed the Red Gum, or Gown; a pimply eruption, of a vivid red colour, rising sensibly above the level of the skin, and intermixed often with dots and red patches, which have no elevation. It is peculiar to very young infants; and often con¬ sistent with good health. See Definition 1. Synopsis, p. xx. Plate /. 5 RidluHtr / . hot A IflrtmtmnffUrjf /frKrf>rmeAjirtmi PLATE II. The Strophulus albidus; which has been denominated by some writers the Jfhite Gum. It exhibits numerous, little, hard, whitish pimples, that remain a ong time, on the face and neck, and, like the red gum, is fre¬ quently unaccompanied by any indisposition, but, like it, is occasionally the indication of disturbance in the alimentary canal. PLATE III. Fig. 1.— The Strophulus confertus; commonly called the ranlc Red Gum, and also, from its frequent occurrence in children a little older, during the commencement of dentition, the Tooth-Rash. It is remarkable for the more extensive crop of papulae, which are smaller, and more crowded, than in the other species; and, in children of seven or eight months, of a higher colour, exhibiting a general redness in each patch. It spreads along the fore-arm, cheeks, and forehead, which are its most common seats, as represented in the plate. Fig. 2. —The Strophulus volaticus, or Feu volage; a less common eruption, which is distinguished by its small circular clusters of papulae, each patch containing from three to ten, which, as well as the interstices between them, are of a high red colour. They rapidly appear in succes¬ sion, turn brown, and exfoliate. Fig. 3.—^The Strophulus candidus; differing from the preceding in the larger size of the papulae, which are smooth and shining, and without any surrounding redness, and stand at a considerable distance from each other. Via.l. /'feJ. I h- 2. Oy/zY^/Jy//^',/ . / V '/^r/Yr^'J. PLATE IV. Comprises two species of Lichen, a non-contagious, papular eruption, affecting adults. Fig. 1. —The Lichen simplex; which is characterized by a scattered eruption of distinct red papula, with a very moderate inflammation sur¬ rounding their base, terminating with a slight scurfy exfoliation of the cuticle. It is liable to be mistaken for the itch, the eruption of which, however, is usually less red, and more humid, being vesicular or pustular, but seldom purely papular. The distinct and distant papulae distinguish it from the measles and scarlatina, for which it has been mistaken. Fig. 2.— ^The Lichen agrius; which is a more inflammatory form of the disease, and marked by the highly red hue of some of its patches, the skin of which becomes at length harsh, thickened, chapped, and excoriated. This tendency, and the diffuse redness, connecting the papula, distinguish this Lichen from the other species. /Va/r /K PLATE V. Fig. 1.— ^The Lichen pilaris; in which t\\Q papula chiefly appear at the roots of the cutaneous hairs. Fig. 2.— Lichen lividus; which is in fact a modification of Purpura, consisting of a sort of papular or elevated petechiae. Fig. 3. —The Lichen circumscriptus; an annulated form of the eruption, less common than the two first, in which the papula are arranged in circular clusters, which have a well defined margin. They are apt to extend them¬ selves by this papulated border, while the central surface becomes even, but continues slightly red and rough. This species was neither figured nor described in the first edition of Dr. Willan’s work. PLATE VI. Contains the three species of Pruhigo, the only remaining disease of this Order, which is characterized by nearly colourless papula:^ with intense itching. Fig. 1.—Prurigo mVis; which is distinguished from Lichen simplex by its soft and smooth papulce, of nearly the same colour as the rest of the skin, and which seldom appear red, except when violently rubbed. As in the following species, minute black scabs become the most visible objects, which form upon them by the concretion of a little watery humour and blood, which ooze out, when their tops are abraded. Fig. 2, and 3.—Prurigo formicans and senilis ; which differ little from each other, or from the preceding species, except that the papulce are larger in the last: these eruptions are more visible from the formation of the little dark scabs just mentioned, than from the appearance of the papula themselves, which are apt to escape observation from their hue. The com¬ bination of these colourless papula, with the little dark central specks upon those which have been abraded and inflamed, as is well represented in the plate, serve to determine the diagnosis, between this disease and the contagious itch. Fig. 4.—Represents an insect, of which a great number were detected on the skin of an old man, affected with Prurigo senilis, by Dr. Willan, who never met with a second instance of the same occurrence. Neither the disease nor the insect was communicated to the patient's wife, or to any of his family. It is obviously not a pediculus; but, both from the structure of its hind legs, and the rapidity of its jumping motion, it was deemed to belong to the genus pulex. . Pr al f///. ,J. FASCICULUS 11. EXPLANATION OF THE PLATES. Tins Fasciculus contains delineations of several species of the two prin¬ cipal genera of the second Order of Cutaneous Eruptions, which are distinguished by the formation of Scales*. There are four genera of scaly diseases, which are denominated Lepra, Psoriasis, Pityriasis, and Ichthyosis. PLATE VII. Lepra vulgaris, the common Leprosy; which is characterized, like all the species of this genus, by “ scaly patches, of different sizes, having always nearly a circular form.'' It appears, first, in small, distinct, red, and shining elevations of the cuticle, on the centres of which thin white scales are speedily formed (as at A). In the course of three or four days, these spots are flattened and dilated, and become more scaly, equalling in size a silver penny (as at B); and they continue to enlarge, still re¬ taining their circular form, to the size of a shilling or half a crown, or sometimes larger (as at D). Occasionally, though rarely, the scales ac¬ cumulate into a thick crust (as at C). The patches are commonly surrounded by a red and slightly elevated border, which generally remains scaly after the central area has recovered its texture in the progress of cure. The leprous patches often appear first at the elbow, or immediately below the knee (as at E). See Definition 2. Synopsis, p. xx. PLATE VIIL Pig. 1.— Lepra alphoides; which differs from the preceding form of the disease chiefly in the small size of the circular patches, which seldom extend beyond a few lines in diameter, and in the minuteness and greater whiteness of the scales. ^ Pig. 2.— Lepra nigricans; which is a more rare form of the disease, differing from the L. vulgaris in the dark and livid colour of its patches, but resembling it in regard to its form and distribution. I’taU.m. 7/iir.rtJiwOnac»Jknm, PLATE IX. Pig. 1.—Psoriasis guttata; a form of the scaly tetter most nearly allied to the Lepra, and characterized by small, distinctj patches of thin scales, with little or no inflammation round them, and without the regular circular figure, or the elevated border of Lepra. Their circumference is often angular, and sometimes slightly serpentine. Pig. 2.—Psoriasis diffusa; which consists of irregular, rough, and reddish patches, of various sizes, interspersed with chops and scales, the surface of which is exceedingly tender and irritable. In tliis variety, the patches are separate; but they are apt to expand till they become confluent. dftrf / 3/rjf^f^flh7K^3virny PLATE X. Fig. 1.— Psoriasis diffusa. Another specimen of the same species, in which the scales are more minute, and more readily exfoliate. Fig. 2.—Psoriasis diffusa ; a variety of the same species, which occurs chiefly about the hands and arms of washerwomen, in consequence of the irritation of soap, and which is generally more highly inflamed, chopped, and tender, than any other variety of the disease. The scales separate in large irregular flakes. PLATE XI. Psoriasis diffusa; a variety of the disease which often affects the back of the hand of bakers, and has been thence called the Bakers itch. It is accompanied with numerous chops and fissures about the knuckles, and the surface is a little tumefied, and the scaliness slight. In his second edition of this plate. Dr. Willan had introduced a figure of the Psoriasis inveterata; but the representation was so totally in¬ adequate to convey any idea of the disease, that it has been deemed necessary to expunge it, and to restore the engraving to its original state. A new representation of this form of Psoriasis will be given in the next Pasciculus, Plate XIII. 4ftra iJA'lSpritmaman AJtrrm PLATE XII. Psoriasis gyrata; which is chiefly distinguished by the singular form and distribution of the scaly patches. These are tortuous and vermiform, or circular and semicircular with tortuous appendages, and are often arranged in a similar manner on each breast, or on each side of the spine. Slight scales are separated from the surface of the patches. In consequence of the imperfection of the original drawing, this plate has been re-engraved. ‘"/•/rM ,•, /: jMtflnim.HurstJfMir '■'■r - FASCICULUS III. EXPLANATION OF THE PLATES. Tins Fasciculus comprises the remainder of the specimens of the second Order, or scaly diseases of the skin; namely, two additional varieties of Psoriasis, and the principal modifications of Pityriasis and Ich¬ thyosis. PLATE XIII. Fig. 1.— Psoriasis diffusa; a variety of the eruption, not figured by Dr. Willan, which occurs almost exclusively in young subjects, affecting the whole surface of the body, and producing a considerable degree of itching and irritation, but without any material derangement of the health. The scales and patches are both more numerous and more minute on the trunk than on the extremities. This drawing was taken from a boy about nine years of age. Fig. 2.—Psoriasis iwoeterata; the most extensive and severe form of the disease, “ is characterized by an almost universal scaliness, and a harsh, dry, thickened state of the skin it begins in separate patches on the extremities, and rapidly spreads over nearly the whole surface of the body. The scales are quickly produced and thrown off, and the skin is red, deeply furrowed, thickened, and rigid, so that motion is often painful and difficult. .P/ateSIl. Fi-ff. 1. Jiffy PLATE XIV. Psoriasis ’palmaria; an obstinate form of the scaly tetter, which is nearly confined to the palm of the hand, but sometimes appears slightly on the inside of the fingers and wrist. The cuticular furrows are deep, and even fissured at the bottom, so as to bleed when the fingers are strongly extended; and the whole surface of the diseased patch is rough, in con¬ sequence of the detached and elevated edges of the scaly cuticle. The complaint is troublesome from the heat, pain, itching, and stiffness which attend it. Aihfithfd JithjfatS^Zmpmanmirrtllett ^eKBvwn PLATE XV. Fig. 1.—PiTYiiiAsis capitis; which, when it occurs in young infants, as here represented, is called the Dandriff. On the upper part of the forehead and temples, it appears as a slight whitish scurf; but on the other parts of the head there are large, flat, semitransparent scales. Fig. 2.—PiTYaiAsis versicolor; a chequered discoloration of the skin, of a brown or yellowish hue, appearing chiefly about the breast, abdo¬ men, shoulders, and upper arms. The discoloured patches are slightly rough with minute scurf or scales, which, however, are not always very conspicuous. Sometimes there is a slight redness in the patches, and then the eruption is accompanied by some degree of itching. V PLATE XVI. IciiTiivosis simplex; the fish-skin disease, which is characterized by a permanently harsh, dry, rough, thickened, and slightly scaly texture of the integuments, generally of a brown or mud-colour. The scales are not deciduous, as in Lepra and Psoriasis. mirm. PLATE XVII. Ichthyosis cruris; a variety of the disease, which occurs in the lower extremities, in some cases of anasarca, forming a rugged coating, which ultimately cracks, and permits a discharge of the effused lymph through innumerable crevices. ehir im rre/y'/Y./. PLATE XVIIL Ichthyosis faciei. The face is often free from the disease, while the rest of the surface is affected with it; but in the case from which this drawing of the eruption was made, it was confined exclusively to the cheeks, the two patches uniting at one time across the nose. The head is imitated from one of M. Alibert’s engravings. p/nTr Wr FASCICULUS IV. EXPLANATION OF THE PLATES. This Fasciculus comprehends the three most important genera of the third Order of cutaneous diseases, Exanthemata, or Rashes *; namely, Rubeola, Scarlatina, and Urticaria. PLATE XIX. Rubeola vulgaris; the common form of measles, as it appears on the fifth day of the fever, and the second of the efflorescence, consisting of an intermixture of small, distinct, and nearly circular spots (A); and of little irregular patches, formed by the coalescence of these, which affect somewhat of a semicircular or crescent form (B), and are slightly raised. Upon the neck and arms a few miliary vesicles sometimes appear, during the height of the eruption, as at (C). See Definition 3. Synopsis, p. xx. "ifatr'JSc. .ntip.'^^i'JXLiMMtfruianMfr.lf.Tlm.Onur X^rvwrt. PLATE XX. Rubeola sme catarrho. This variety has been observed, during an epidemic season, in a few rare instances, in which the eruption of measles went through its stages, unaccompanied by any symptoms of fever, ophthalmia, or catarrh. It is so far important, however, that it does not secure the constitution from a subsequent attack of the febrile measles. PLATE XXI. Fig. 1.— Rubeola nigra. Dr. Willan gave this appellation to an unusual appearance, which he had sometimes seen about the seventh or eighth day of measles, the rash becoming suddenly black, or of a dark purple colour, with a mixture of yellow. It has continued ten days, or longer, without materially disturbing the functions of the patient. Fig. 2.—Is a representation of the Rubeola vulgaris, about the eighth day, when it is declining, and assumes a slightly yellowish hue. riatr-MT. ra/ur /y ///r /'///yy/y/ PLATE XXII. Scarlatina simplex; the rash of scarlet fever, when it is not attended bj ulceration of the throat. It is at first composed of innumerable red points (as at A, Fig. 2.), which on the following day coalesce, or are extended into an almost continuous efflorescence, especially over the cheeks and limbs; and on these parts, the miliary glands and papillae of the skin are so much distended with blood, as to be raised into minute papulae, which produce a roughness of the surface, like the cutis anserina (as at Fig. 1. B); and sometimes into miliary vesicles (as at Fig. 1. A). But there are commonly many interstices of skin-colour, of very irre¬ gular forms (as at C.). When the eruption begins to decline, the scarlet hue becomes less vivid, and the interstices are very numerous, as at the commencement (Fig. 2.). Fig. 3. represents the speckled appearance, which often shews itself in a scurfiness (A), or in little patches of cuticle, which have sometimes been mistaken for vesicles (B). PLATE XXIII. Fig. 1. represents the inflamed and elongated papillae of the tongue, in Scarlatina anginosa. Fig. 2. The eruption of Scarlatina anginosa on the arm; shewing the goose-skin appearance from minute papulae (as at A), and the general fulness of the cutaneous vessels (as at B). Fig. 3. The rash of Scarlatina maligna, of a darker hue, and inter¬ mixed with Petechiae. A'irt/.,,.,/ y,/',/ PLATE XXIV. Fig. 1.—Urticaria emnida, a chronic form of nettle-rash, in which the wheals are not stationary, and are sometimes round, and sometimes oblong, like the strokes of a whip. They are never surrounded by an extensive blush, but sometimes slightly red round the base. Fig. 2.— Urticaria febrilis, a species of nettle-rash, which is pre¬ ceded by some degree.of fever, and in which the wheals appear in the midst of irregular patches of a vivid red hue, which fades during the day, but returns in the evening, with a slight febrile paroxysm. The patches are often a little elevated, and give some degree of tension and hardness to the skin, and terminate by slight exfoliations of the cuticle. /'Mr XXIV. YY’iW/i'/ /’/'ff/l/i ■//// J Smihar Jar!// FASCICULUS V. EXPLANATION OP THE PLATES. This Fasciculus contains the fourth and fifth genera of the third Order of cutaneous diseases, or Rashes; namely, the principal varieties of Roseola and Purpuua. PLATE XXV. Fig. 1.— Roseola (estiva: a rose-coloured rash, which chiefly occurs in summer, and is preceded by slight febrile indisposition for a few days. It differs from the Rubeola in the larger size, and more irregular forms and distribution of its patches; and from Scarlatina it is still more dis¬ tinguished by the roseate hue, and by its mode of distribution. Fig. 2.—Roseola autwnnalis; consists of distinct circular patches, of a damask hue, occurring principally on the arms of children from five to ten years of age, in autumn, and disappearing in about a week. PLATE XXVI. Pig. 1.—Roseola annulata, appears in rose-coloured rings, with central areas of the usual colour of the skin. The rings are at first minute, but gradually dilate, in the order A, B, C, and E, sometimes to nearly half an inch in diameter. Pig. 2.—Roseola infantilis, is a closer rash than the R. cestwa, leaving very small interstices. It occurs in infants during any irritation occa¬ sioned by dentition, fevers, or bowel-complaints, and is very irregular in its duration, sometimes continuing but for a night, and sometimes appearing and disappearing for several successive days. It has been sometimes mistaken for measles and scarlatina. PLATE XXVII. Pig. 1. and 2.— Roseola variolosa; a rash which occurs during the eruptive fever of both the inoculated and the casual small-pox, first on the arms, breast, and face, and on the following day it extends over the trunk and extremities. In some cases it forms contiguous arches, (as in Pig. 1.) and in others longitudinal irregular patches, with small dis¬ tinct dots intermixed (Pig. 2. B.) Pig. 3.—Roseola vaccina; an efflorescence which commonly appears in a congeries of dots and small patches, as here represented, but is sometimes diffuse, like the variolous rash. It usually occurs at the same time with the areola, and round the inoculated part. A PLATE XXVIII. Fig. 1.—PuEPURA simplex; the least complicated form of the “ pete- chiae sine febre" of authors, consisting only of minute effusions of dark blood under the cuticle, usually termed petechise. Fig. 2.— Purpura licemorrhagica ; a more severe modification of the disease, in which the effusions under the cuticle are more extensive, forming ecchymoses and vibices, and are accompanied by actual haemorrhages from those parts where the cuticle is so delicate as to be easily ruptured, and therefore chiefly fi’om the internal parts. The colour of the spots, in both varieties, is different at different periods of their continuance; being brighter on their first appearance, and becoming subsequently purple or livid, and lastly brownish or yellowish, when the effused blood is nearly absorbed. Stnitt d^irtt PLATE XXIX. Fig. 1.—PuEPURA urticans, is characterized by commencing with hard, reddish, and rounded elevations of the cuticle, resembling wheals, but not accompanied by any tingling or itching. These little tumours gradually dilate, but within a day or two they subside into livid spots of the same extent. On the extremities, where they most frequently appear, they are often mixed with petechise. Fig. 2. and Fig. 3. are intended to shew the relative characters of petechiae and flea-bites; the latter being distinguished by a central puuctum, which remains under pressure, while the surrounding red¬ ness disappears. /7<t/rsxrx. PLATE XXX. Purpura senilis. This form of the Purpura was not noticed bj Dr. Willan, nor in the two first editions of my s 3 mopsis. A few cases of it have occurred, with considerable uniformity of character, in elderly women. It appears principally along the outside of the fore-arm, in successive dark purple blotches, of an irregular form, and various mag¬ nitude. Each of these continues from a week to ten or twelve days, when the extravasated blood is absorbed. A constant series of these ecchymoses had appeared in one case during ten years, and in others for a considerable period •, and in all, the skin of the arms was left of a brown colour. The health did not appear to suffer materially, as in the other forms of Purpura. 1 Ihnmi lanTt Mfi. /ttir.xl./trrxAvie ARrrmt. FASCICULUS VI. EXPLANATION OF THE PLATES, In this Fasciculus, the third Order of cutaneous eruptions is completed bj the representation of the varieties of Erythema ; the fourth Order, is illustrated by two varieties of Pompholyx ; and the fifth Order, PustulcB, is commenced with the three species of Impetigo. PLATE XXXI. Fig. 1.— Erythema papulatum. An eruption, chiefly affecting the arms, neck, and breast, in extensive irregular patches, of a bright red hue; but which consists for the first two days of imperfect papulae, which disappear as the efflorescence brightens. The skin continues red and furrowed for ten days or a fortnight; and a blueish or livid hue succeeds the decline of the rash. Fig. 2.—Erythema tuberculatum. This eruption somewhat resem¬ bles the former in its irregular and bright patehes, in which, however, there are dispersed small round tumours, slightly elevated, but not so hard as tubercles, which subside in about a week. The erythematous patches turn livid about a week afterwards, and gradually disappear. ^r/^Z/rr/nm ^l■a^fa/^ry-f/^7>/^' PLATE XXXII. Fig. 1.—Erythema nodosum. This rash usually affects the fore part of the legs, and seems to occur only in women. Many of the patches are of an oval form, the central parts of which are very gra¬ dually elevated into hard and painful protuberances on the 6th or 7th day, from which time to the 10th they constantly soften and subside, the red colour turning blueish or livid on the 8th or 9th day. Fig. 2.—Erythema marginatum. This eruption was not delineated in Dr. Willan's work ; but the little figure, here substituted for an obscure representation of a supposed syphilitic erythema, was found among his drawings. The erythema marginatum occurs in large patches, which are bounded on one side by a hard, elevated, tortuous, red border, in some places obscurely papulated; but have no regular margin on the open side. The duration of the disease is variable, from three to six weeks. /fa/r-XWl. ^Sr//./Jx T//.Uwmf7 ma r,/'//fr/7f. m./ PLATE XXXIII. It was scarcely necessary to figure so common a disease as Erysipelas; and this representation of Pompholyx, therefore, constitutes i^he only illustration of t\i& fourth Order of Cutaneous Diseases, Blebs, or Blains. Eig. 1.— Pompholyx diutinus. “ An eruption of hullce, without any inflammation around them, and without fever.'^ The vesications seem to commence from red tingling elevations of the cuticle, nearly resem¬ bling papulae (as at A.); these rise into transparent vesicles (as at B.); which become yellow, and enlarge (as at C and D.); break and inflame (as at E); and at length form a scab on the excoriated surface (as at S.). Fig. 2.—Represents an appearance of the Pompholyx, which is some¬ times connected with the Prurigo formicans. See Definition 4. Synopsis, p. xxi. xmiL. hibKxh^J/m/j PLATE. XXXIV. With this Plate the new series ot engravings commences, and also the fifth Order of Cutaneous Diseases, the Pustules, Fustulce; on which subject Dr. Willan had given nothing to the public, his treatise having extended no farther than the fourth Order. Impetigo ^o-i/ra^a, the first species of the pustular, or humid tetter, is characterized by circumscribed patches, a little elevated, which at first consist of clusters of psydracious pustules, * closely congregated, and surrounded by a slight inflammatory mai’gin ; but after some days, the pustules break, and an irritating humour exudes, which soon con¬ cretes into yellowish or greenish-brown scabs. These patches are often situated on the arm and wrist, and extend to the back of the hand, and one of them not unfrequently takes its station between the metacarpal bones of the thumb and forefinger, as here represented. See Definition 5, b. Synopsis, p. xxi. '' /^(/ rrr /a. ^tiSxhfd.4vi! i ai6 hvrjmammJIurstMee.n Ome k'Rvm' PLATE XXXV. Impetigo sparsa; -which differs from the preceding species rather in the indeterminate and extensive distribution of the pustules and scabs, than in its general character. It is commonly, however, a more severe disease, and connected with more constitutional derangement than the l.Jigurata. In the lower extremities, especially, it is often extremely obstinate and severe, continuing for many weeks, and even passing into the next species. Drawn W T. B. £np ffyj. Sfrwart , PLATE XXXVI. Impetigo scabida; which is distinguished by the formation of a thick, yellowish, scabby crust, by which the whole limb or limbs are encased, and which is often separated by many fissures and cracks, from which a thin ichor copiously exudes, and concretes into, additional and irre¬ gular layers. The whole crust, indeed, is the result of the concretion of this acrimonious humour, which is discharged in great abundance from numerous psydracious pustules, as they successively form, break, an^ ulcerate over the surface of the limb. FASCICULUS VII. EXPLANATION OF THE PLATES. This Fasciculus comprises six specimens of the formidable and unsightly genus PoREiGO, the second in the Order of Pustules. PLATE XXXVII. PoRRiGO larvalis, the Crusta lactea of medical authors, is almost exclusively a disease of infancy, occurring during the period of lacta¬ tion; whence its popular name. It is commonly confined at first to the forehead and cheeks, but usually extends to the scalp and ears, and sometimes to the breast and extremities. It consists of an eruption of numerous, minute, and whitish pustules, denominated achores,* which are crowded together upon a red surface, upon which, as they break and discharge, thin yellowish or brownish-green scabs are formed by the concretion of the viscid humour. The whole face is thus often enveloped as it were by a mask, whence it has acquired the epithet lar¬ valis. Notwithstanding the extent to which the infant is disfigured, no permanent scar or deformity ever ensues. See Definition 5, c. Synopsis, p. xxii. i-htrjsxm. /i/r/'rr/y^. PLATE XXXVIII. PoRRiGO furfurans. Instead of concreting into thick scabs, the humour, which exudes in very small quantity, dries speedily, and sepa¬ rates in thin laminated scabs, or scale-like exfoliations. The scalp is usually affected extensively with the furfuraceous porrigo, and becomes tender and sore. The disease is commonly limited to the scalp, but occasionally extends to the external ears, and a little on the forehead and temples, beyond the roots of the hair, as in the case from which this drawing was made. It occurs principally in adults, or in persons attaining to the period of puberty. PLATE XXXIX. PoRRiGO scutulata; popularly known by the name of Ringworm; an unmanageable and very contagious variety of the disease, which, though as old as the Greeks, has recently been propagated extensively, by the multiplication of boarding-schools and manufactories, in this country. It commences with clusters of small achores, or pimple-like pustules, in distinct small patches, of an irregularly circular figure; which are some¬ times limited to one scutulurn, and sometimes numerous, and distant. Though the exudation is commonly- small, yet, if neglected, it will con¬ crete into thin scabs: the areas of the patches also dilate, and become confluent; and the hair upon them becomes lighter in colour, and at length is destroyed at the roots, leaving patches of baldness. ■/afrJOmX PLATE XL. PoRRiGO decahans; a variety, which is also called ringworm, and which may sometimes be the result of the decalvating process of the preceding species. In general, however, there is no manifest appear¬ ance of disease in the patches of this species, except complete baldness, of a very white and smooth appearance, and in form more or less circu¬ lar, while the hair surrounding the patches is as thick as usual. I’/aItJL. PLATE XLI. PoRRiGO/atJosa, the scalled head, consists of an eruption of the large, soft, straw-coloured pustules, denominated Favi.* This Scall, however, may occur on all parts of the body, and not unfrequently affects the face and limbs, and even the trunk. The scab which results from these pustules, wherever they appear, is very characteristic; being generally soft, yellowish, or greenish, elevated, and semi-transparent, with a very irregular surface, indented into hollows; whence the term honey-comh scab has been applied to it. This is particularly conspicuous when it occurs on the face. Considerable ulceration often takes place under these scabs, especially when they are much irritated by picking and scratching them about the edges; and the neighbouring glands usually exhibit marks of irritation. See Uefiuition 5, d. Synopsis, p. xxii .V/./. PLATE XLII. PoRRiGO favosa affecting the face. As in this situation the scab, which succeeds the favous pustules, is conspicuously characterized, I deemed it right to give this view of it, in preference to figuring the Porrigo lupinosa, which indeed is of such rare occurrence, that I have not been able to procure a good drawing of it since the commencement of this undertaking. Notwithstanding the extreme deformity occasioned by this scall, it often yields readily (as in the case from which this draw¬ ing was taken) to medical treatment, and leaves no scar behind; a cir¬ cumstance which renders it important to distinguish it from the varieties of Lupus, Scrofula, and other scabby ulcerations. FASCICULUS VIII. EXPLANATION OF THE PLATES. In this Fasciculus the fifth Order of cutaneous diseases, Pustul®, is completed bj the representation of four specimens of Ecthyma, and three of Scabies ; it being deemed unnecessary to figure the varieties of that well known eruption, Variola, of which I am in possession of several excellent drawings, procured by Dr. Willan. The two remain¬ ing plates of this Fasciculus exhibit the varieties of the first genus of the sixth Order, which is characterized by the formation of Vesicles,* namely. Varicella. PLATE XLIII. Fig. 1.— Ecthyma vulgare : an eruption of the large pustules, deno¬ minated phlyzacia, -f- occurring principally on some part of the extre¬ mities, and gradually enlarging and inflaming, for a week or ten days, one after another, Avhen they break, pour out their pus, and afterwards a thinner fluid, which concretes into brownish scabs. In about a week more, the inflammation subsides, and the scabs soon afterwards fall off. The various stages of the pustules are here delineated, in a case of some severity. In the milder cases, they often do not exceed in size the pustule near the wrist. Fig. 2.— Ecthyma luridum; is characterized by the darker hue of the bases of the phlyzacious pustules, and by the long and slow succes¬ sion in which they spread over both the trunk and limbs, for a period of several weeks. When they break, a curdly or sanious discharge issues, and dark hard scabs form by its concretion, and remain sur¬ rounded by dark inflamed borders till they are about to separate. These two figures are from Dr. Willan's collection of drawings. See Definition 6. Synopsis, p. xxii. t Definition 5, a. ibid. p. xxi. ri^.2. 2UU jzm. PLATE XLIV. Ecthyma cachecticum. This species of Ecthyma was not noticed in the first and second editions of my Synopsis, whence it may be neces¬ sary to notice it more at large here. These two figures present specimens of the two most common forms of an extensive eruption of phlyzacious pustules, which not unfrequently occurs, in connection with a state of cachexia, resembling that which is produced by the operation of a morbid poison in the habit, and is often treated as syphilitic. It is usually preceded for two or three days by a febrile paroxysm, after which numerous pustules, with a hard in¬ flamed base, arise in daily succession, going through their successive stages of inflammation, suppuration, scabbing, and desquamation, so that, in the progress of the disease, they are commonly seen under all these conditions at the same time, as represented in the plate. The pustules which occupy the breast and abdomen are generally less pro¬ minent, and contain less matter than those on the face and arms. The febrile symptoms are diminished, but not removed, on the appearance of the eruption ; for a constant erethism or hectic continues during the progress of the disease, with great languor and depression of strength and spirits. It is also accompanied by pains in the head and limbs, and commonly by some degree of ophthalmia, and by a slow inflammation, with superficial ulceration, of the fauces. The duration of these complaints is considerable, extending to eight, ten, or twelve weeks, but yielding at length to the use of sarsaparilla, and cinchona, with the assistance of alteratives. :xLiv PLATE XLV. Scabies lymphatica. It is difficult to give a distinct representation of the almost invisible vesicles of scabies; and this engraving expresses rather too strongly the slight inflammatory redness, which accompanies them, having exceeded the drawing in that respect: but it exhibits the distribution of the disease, in a well marked case, pretty distinctly. PLATE XLVI. Fig. 1.—Scabies purulenta; or pocky itch. The size, prominence, and purulence of the eruption in this form of itch, which is here faith¬ fully represented, frequently mislead the observer, who allows this severe disease to go on for a considerable time without applying the specific, to which it speedily yields. Where the pustules coalesce, they form irregular blotches, which sometimes ulcerate to some extent, and afterwards form hard and dry scabs. Fig. 2.—Scabies porcina. It is well known that a severe scabies is sometimes excited by the contact of dogs, cats, pigs, &c. affected with the mange. The vesicles and pustules are generally numerous and rank, and the general surface of the skin becomes rough, and of a dirty or brownish hue. The case, from which this drawing Avas made, occurred in a man Avho had attended a mangy hog. PLATE XLVII. The first genus of the numerous Order of Vesicles is the Varicella, Chicken Pox, or Swine Pox. The three varieties, which the Varicella assumes, have been introduced into this plate. The vesicles on the upper arm are the common lenti¬ cular eruption, which is peculiarly called Chicken-pox ; those on the fore¬ arm are the more acuminated conoidal vesicles, which have received the appellation of Swine-pox ; and the hand and wrist exhibit the glohated vesicles, which, in the north, have been distinguished by the name of Hives. The intermixture of rising vesicles, with those that are puckered and subsiding, and others that are drjdng into scabs, on the fifth or sixth day, as here represented, constitutes a principal point in the diag¬ nosis between this eruption and small pox. PLATE XLVIII. This plate, from a drawing of Dr. Willan^s, represents a full eruption of the lenticular varicella, with some intermixture of conoidal vesicles. The little circumscribed brown scabs, here and there formed, while the rest of the eruption is full, mark the character of the disease, together with the form of the vesicles, although they have assumed a yellowish, or almost purulent appearance. FASCICULUS IX. EXPLANATION OF THE PLATES. This Fasciculus exhibits the principal species of tivo genera of the Order Vesiculce; namely, Herpes and Rupia. PLATE XLIX. Her PEs phlyctcenodes. In this form of Herpes, the vesicles are usually smaller than in the Shingles, and the successive clusters extend upon the limb longitudinally, and do not encircle it as the latter eruption surrounds the trunk. The progress of the patches downivards is marked in the plate by the incrustation of the upper one, while the smaller ve¬ sicles of the lower one are forming. J’lntr XUX. PLATE L. Herpes zoster; commonly termed the Shingles; a species of Herpes peculiar to the trunk of the body, and generally spreading half round, by a succession of irregular clusters of the vesicles. As the patches, which first appeared, subside, the vesicles become partially confluent, and assume a livid or blackish hue,, and terminate in thin dark scabs. This complaint is generally of little importance, but is occasionally accompanied, especially on the decline of the eruption, by an intense deep-seated pain in the chest, which is not easily allayed by medicine. enMUmn-. PLATE LI. Fig. 1.— Herpes circinatus. The plate represents one of the most extensive varieties of this species of Herpes. The patches are often much smaller, consisting of little rings of vesicles, not much larger than a shilling, and accompanied by very slight redness. In children it is called the ring-worm, and sometimes mistaken for the porriginous disease. Fig. 2 and 3. —Two specimens of the Herpes prcBputialis, a form of the disease, which, from its situation on the prepuce, is liable to be con¬ founded by the patients themselves, and by ignorant practitioners, with chancre. The drawings represent the progress of the eruption, which generally consists of a single patch, in two cases, and the numbers mark the days on which the drawings were made; namely, in Fig. 2, on the second, fifth, and eighth; and in Fig. 3, on the second, third, fifth, and sixth days. ^bHthcdJa»^u/UfinZm<tman.l6irjt.'Bcfj.Prme kBrewrii PLATE LIE Herpes Iris. This rare and curious variety of Herpes occurs prin¬ cipally in the situation in which it is here figured, but sometimes in the palms of the hands, or on the instep. The vesicles are not large or elevated, but sufficiently distinct to characterize the disease. They are disposed in two or three concentric rings, Avith a central vesicle, Avhich arise in succession, as in the other forms of Herpes. fv. PLATE LIII. Rupia simplex. All the forms of this eruption are connected with a cachectic state of the constitution, and some of them, like the one here figured, are accompanied by symptoms resembling those produced by a morbific poison. It will be seen that they differ from the Ecthymata in the form and size of the eruption, and in the colour and consistence of the contained fluid, consisting in fact of flattened muddy vesicles, and forming a larger and more circular scab. Jiliilitfietf t fmt j joy iylflt!ft PLATE LIV. Rupia prominens. I am indebted to the liberality of a professional friend, distinguished by the union of graphic with anatomical science, for this excellent representation of this form of Rupia, which greatly exceeds in the expression of character the drawings which I had pre¬ viously procured. It exhibits very distinctly the original vesicular form of the eruption, and the limpet-shell appearance of the scab. FASCICULUS X. EXPLANATION OF THE PLATES. In this Fasciculus the remaining genera of the Order VESicuLiE are comprehended; namely, Miliaeia, and Eczema ; and as a substitute for the genus Aphtha, which required no graphical illustration, I have been enabled to figure the vesicle or carbuncle of the Plague, which I trust Avill be deemed an acquisition. The last Plate commences the seventh Order of Tubercles, including specimens of Molluscum and Vitiligo. PLATE LV. Fig. 1.—Miliaria. The miliary eruption, Avhen it affects the ex¬ tremities, as here represented, is less copious than on the back, neck, and breast, ivhere it is liable to occur only as a symptom of fevers, in Avhich much heat of the skin and sweating have been accidentally excited. Fig. 2.—Eczema impetiginodes. This local variety of Eczema chiefly affects the back of the hands, about the knuckles, or in the situa¬ tion here figured. After a succession of rising vesicles, an inflamed and irritable state of the skin is induced, forming a patch of an irregular circular form, which is hot, itches, and is disposed to crack, but on which neither scabs nor pustules form, as in Impetigo. /to /J' PLATE I.VI. Eczema solare. This form of the disease may arise from various sources of irritation, but is most common in summer, being the result of the direct irritation of the sun or heated air, and hence occurs on parts most exposed to their influence, more particularly on the back of the hands and fingers, as here represented. ^C^r'zrm/r jr/ff /r . PLATE LVII. Eczema rubrum. This form of Eczema varies somewhat in different cases; but always appears under the form of minute vesicles, accom¬ panied by a diffuse redness, Avhich the roughness and elevation of the vesicles distinguish from simple Erythema. This disease has been ob¬ served to follow exposure to cold, and to recur in the same individual at irregular intervals without any manifest cause. /Wr IVIL. ‘'(yr ir/z/t/ PLATE LVIII. Eczema ruhriim mercuriale. The most remarkable and common form of Eczema rubruni is that which results, in some constitutions, from the irritation of mercury. The hue of this eruption is commonly less florid than that of the former variety, or of a browner tint; though we have seen it highly florid in one or two instances. The distribution and extent vary infinitely in different cases, and the specimen here figured can give but a general notion of either. PLATE LIX. Vesicle and Carbuncle of the Plague. The liberality of Dr. Calvert, physician to the Army at Malta, enables me to give a representation of this pestilential eruption, which, as its first appearance is in the form of a vesicle, not much unlike that of the cow-pock, I place here. (See Fig. 1.) The progress of the vesicle to the tumid and fiery ulcer of the carbuncle is delineated by the pencil of Dr. Calvert in four successive stages. llah’ZJT. PLATE LX. Fig. 1. and 2. represent the decline of the eruption of Vitiligo, in which the elevations appear to have subsided nearly to the level of the surface, chequering it in a singular manner. I have seen little of this rare disease, and am unacquainted with the whole progress of the case from which this drawing was accurately made by Mr. H. Thomson. Fig. 3.— Molluscum pendulum. This drawing was procured by Dr. Willan (a small portion of it only being here figured) from a case which occurred under his own observation. Some of the tubercles were con¬ siderably larger than those included in the present figure; yet, like the poor man of Muhlberg, whose portrait was published by Prof. Tilesius, he appeared to suffer neither indisposition nor material inconvenience. fliiU IX. FASCICULUS XL EXPLANATION OF THE PLATES. In this Fasciculus the seA^enth Order of Tubercles is continued. It com¬ prises, besides an undescribed species of Molluscum, all the species of the common tubercular eruption, Acne, and of Sycosis. PLATE LXI. Molluscum contagiosum. This singular eruption had not been noticed by Dr. Willan, and Avas unknoAvn to myself till after the publi¬ cation of tAvo editions of my Synopsis; it may, therefore, be proper to give a fuller account of it than is usual in this Avork. The peculiar cir¬ cumstances Avhich distinguish this species of Molluscum from the com¬ mon excrescences of that name are its contagious quality, and the emission of a milky fluid from an imperceptible aperture in the apex of most of the larger tubercles, upon pressure; by means of Avhich fluid it is probable that the disease is inoculated. The young Avoman, Avhose face and neck Avere disfigured in the manner represented in this plate, had received the eruption from a child Avhom she nursed, on Avhose cheek a large tubercle of the same kind existed, Avho had doubtless been infected by a former nurse, on Avhose face the same eruption had been observed, and Avho had communicated it also to tAvo other children in the family. I have subsequently seen this eruption in another child, Avho had apparently been infected by an older child, Avho Avas in the habit of nursing it, and on Avhose face the same tubercles, Avith the milky fluid, previously appeared. The tubercles are hard, smooth, and nearly of the colour of the skin, but Avith a shining surface, and a slight appearance of transparency: they are generally of a globular form, sometimes ovate and sessile upon a contracted base. Their progress is not very rapid ; but some of them, on attaining a considerable size, pro¬ ceed to a slow and curdly suppuration; and, in the case here figured, the cervical glands, under those on the neck, were swollen, and the sur¬ face Avas somewhat discoloured. PLATE LXII. Acne simplex; Acne punctata. These two species of Acne so constantly occur together, as in the case here engraved from a drawing of Dr. Willan’s, that it was not deemed necessary to figure them sepa¬ rately. The black puncta, indeed, sometimes appear on the top of in¬ flamed tubercles, which they have excited, being, in fact, little plugs of hardened mucus or sebaceous matter, irritating and over-distending the little ducts of the sebaceous glands, in which they are lodged. In general, however, these puncta are surrounded only by a very slight raised border of cuticle. I^nle liXir. PLATE LXllI. Acne indurata. This accurate representation of the more violent and indurated species of Acne was procured and already engraved for Dr. Willan^s work. The various forms, acuminated, conical, or oblong and conoidal, which the tubercles assume, are depicted in the plate, as well as the livid hue which they put on in their progress, especially those which do not proceed to suppuration. mtfUiu. PLATE LXIV. Acne rosacea. This species is somewhat different from the pre¬ ceding, as it is accompanied with general redness, which commences on and spreads from the end of the nose, on both sides, to the cheeks. In the progress of the disease, the cuticle becomes thicker, and its surface uneven, and variegated by reticulations of enlarged cutaneous veins, with smaller red lines, sometimes stretching across the cheeks. J’/atrLUK /yw/r^f/^.' PLATE LXV. Sycosis menti. The tubercles in this eruption, which almost exclu¬ sively affects men, usually appear first on the under lip, or prominent part of the chin, in an irregular cluster: but other clusters and single tubercles soon follow, often covering nearly the whole surface on which the beard grows, up to the ears, and under the jaw towards the neck. The tubercles are red and smooth, and nearly equal to a pea in magnitude, but of a conoidal form. As they suppurate slowly and par¬ tially, and discharge a small quantity of thick matter, by which the hairs of the unshaven beard become matted together, that appearance like the pulp of a fig, which has given origin to the name of the disease, and which is here represented on the chin, is often produced. PLATE LXVl. Sycosis capillitii. This variety of Sycosis, affecting the hairy scalp, is seated chiefly about the temples, near the external ear, forehead, and occiput, near the margin of the hair. The tubercles arise in clusters hke the former, but are softer and more acuminated than those on the chin, and pass more rapidly into suppuration, soon becoming confluent, and producing an elevated, unequal, and ulcerated surface. This is also sometimes granulated, affording some resemblance to the inside pulp of T/atrim. FASCICULUS XU. EXPLANATION OF THE PLATES. In this concluding Fasciculus are exhibited two formidable diseases of the tubercular Order, Lupus, and Elephantiasis; and specimens of the principal varieties of the genera Ephelis and Na^vus, which con¬ stitute the eighth Order, Macula. PLATE LXVIL Lupus, noli me tangere. This representation of the extensive ulcera¬ tion of the face, occasioned by this severe and unmanageable disease, was procured and already engraved at the instance of Dr. Willan. It produces even more deformity than Elephantiasis, Avith Avhich it is sometimes confounded; but from which it differs essentially in its character and progress. It has been sometimes also deemed cancerous; and the circumstance of an occasional cure having been effected by the use of arsenic has probably given rise to the opinion that that medicine has proved a remedy for cancer. PLATE LXVIII. Elephantiasis. This hideous disease is fortunately never seen in this country, except in a few individuals, natives or residents of more southern climates. This was the first case that had occurred to my notice, and I am indebted to the kindness and liberality of my friendj Mr. Lawrence, for the opportunity of procuring this excellent repre¬ sentation of the disease, as it appeared in the boy, Charles Uncle, a patient in St* Bartholomew’s Hospital, whose case has been detailed by Mr. Lawrence, in the sixth volume of the Medico-Chirurgical Trans¬ actions, for the year 1815. The engraving here given is an exact por¬ trait of that individual, after the tubercles had been rendered a little smoother than they originally appeared by the application of poultices. mtrjxvju. PLATE LXIX. Ephelis. This representation of the large dusky patches, which differ from freckles only in their extent, and in occurring also on parts of the skin not exposed to the direct influence of the sun, was already engraved for Dr. Willan's work. These discolorations approximate in their character to the Pityriasis versicolor, but are more diffuse, and generally of a darker brown hue, and never shew any tendency to the minute furfuraceous exfoliations, Avhich often accompany that affection. r i PLATE LXX. NiEVUS maternus; mother-spots, &c. This and the two • following plates exhibit some of the varieties of those discolorations and ex¬ crescences of the skin, with which dilferent individuals are marked from their birth. In consequence of the absurd popular notion, that these congenital alterations of the texture of the skin originate from impres¬ sions of various external objects on the senses and imagination of the mother during gestation, they have received various appellations, cor¬ responding with the objects which they have been supposed to re¬ semble. The specimens here figured were among the drawings pro¬ cured by Dr. Willan, with the names here annexed to them. The two on this plate, ■ from their resemblance to a leaf and a cherry, Avere called RYVs foliaceus, and cerasus. HatrXXX PLATE LXXI. Eig. 1. This is one of the most common forms of the Njevus, and is sometimes compared to the stain of port-wine, or claret. Fig. 2. Njevus araneus, being supposed to bear the likeness of a spider. J^aftZZgL. Fi{j. 2. ^ I/-r/.r/.y / ///'^ PLATE LXXII. This drawing exhibits an unusual number and variety of congenital marks, all occurring in the same individual. ^ h Jbtr.tt. Httr fJhnr jtHnwf,.