Licence: Public Domain Mark
Credit: A manual of medical diagnosis / by A.W. Barclay. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![iimore livid colour, the tension subsides, and is fol- Uowed by what is called a “ boggy” feeling, which is jpartly produced by superficial cedema, partly by puru- lleut infiltration and deep-seated fiuctuation. In tracing the main features by which diseases of the skin are I'to bo discriminated, and applying to them the rules of diagnosis, vwe are in great measure restricted to tlie distinct objective pheno- rmenou which each case presents in addition to its other and more ^general symptoms. In many cases the inspection of the eruption lis all that is wanted to determine its classification ; and this is eespecially true of what may be called typical examides, but (luito sas frequently our judgment is iiiHuenced by other circumstances ^which the history of the case records. Practical hahiiude can ; alone give tlie power of determining which among these have .any direct hearing on the cutaneous aifection ; and the educated (eye can often determine the class to which any case belongs from iits general aspect and history, without entering on a minute ex- lamination of its specific character. When seeking for the solution of a difficulty, .subordinate mat- I ters must not be neglected, such as the station in life, the probability lof hereditary taint, of unsuitable food, or of exposure to infection, 'which the ai)pcarance and manner of the patient suggest. With (this object the physician may be induced to ask many (piestions which seem to have little to do with the skin : umiuestionably in a great many instances it is true that the more correct the history of the patient’s past life, the more certain is the diagnosis ■ of any particular ailment. I will add a few illustrations of the ■ manner in which these additional facts afford hints for our guidance in diagnosis. A febrile state more or less accompanies erythema and roseola, hut seldom coexists with urti<;aria, and its comparative mildness separates these from erysipelas, j)hlegmon, measles, and scarlatina. It distinguishes the acute from the chronic form of eczema, and marks the boundary very often between eczema impetiginodes and true impetigo. It draws an equally clear line of demarcation be- tween pemphigus and rupia. It is always])rescnt with herpes, but when the fever is severe, theenqition is ceitainly only subordinate to some internal disease. Insufficient nutriment or exhaustion of body cause many of the varieties of skin disease to assume a suppurative character ; the bearing this in mind will often lead to the discovery of the true original lesion where lichen, eczema, or scabies have undergone such a change, d'he same causes, as tiicy cxidain the presence of ecthyma and rupia, guard against the needless assumption of a syphilitic taint. I’overty and dirt alike go hand in hand with scabies and prurigo, but with the latter there is poverty of blood as well as of purse. The character of the food recently taken has often a definite relation to urticaria.](https://iiif.wellcomecollection.org/image/b24989812_0613.jp2/full/800%2C/0/default.jpg)
