§ 114. Miliaria.

This eruption consists of small, round millet-sized vesicles (and frequently still smaller than a millet-seed, and perceptible only to the finger): they appear scattered over the body, are surrounded by a slight inflammation, and appear at irregular periods during a feverish state of the organism. Precursory symptoms are: profuse sour- smelling sweats from the commencement of the fever, oppressive anxiety on the chest, heavy (not short) moaning, frequently sighing breathing, dry, short cough, restlessness, frequent creeping chills, stinging and itching of the skin, sometimes nervous attacks, spasms, delirium. These symptoms sometimes abate on the breaking out of the rash.

The eruption is sometimes very slight, sometimes extremely violent, particularly on the neck, chest, and back; in many cases the whole body except the face is covered by it; in other cases the eruption consists of single spots scattered irregularly over the surface of the body, and remains visible for several days. The skin being inflamed, and the fluid contained in the vesicles being quite clear and transparent, the vesicles look red for about thirty hours, after which the fluid becomes opaque and milky. This change has given rise to the denomination of red and white miliaria.

Miliaria is generally a symptom of a more deep-seated disorder - fever, etc. It is difficult to say how long such a rash lasts, inasmuch as new vesicles are constantly breaking out: we can, however, state, that it disappears between the seventh and fourteenth day. If the eruption should make its appearance on the seventh, eleventh, and fourteenth day, accompanied with a general abatement of the symptoms, we ought to look upon it as a favourable critical phenomenon.

§ 115. There are various kinds of miliaria, which, of course, require different remedies. The indolence, anxiety, oppression in the praecordial region, uneasiness, moaning, and other symptoms which generally precede the eruption in puerperal, mucous, and other fevers, are most speedily and certainly relieved by a few doses of Ipecacuanha or Bryonia. If the anguish be excessive, and compel the patient to shift his position all the time, Arsenic deserves a preference over either Ipec. or Bryonia. If the anxiety be attended with a violent orgasm of the blood, great internal and external heat, Aconite is the specific, although Belladonna is likewise useful when delirium, congestion of the blood to the head, bloatedness of the face, red and glistening eyes, are the characteristic symptoms. If the restlessness proceed from nervous irritation without much anxiety, Coffea is a suitable remedy.

Miliaria of lying-in women and their infants are most speedily removed by Bryonia and sometimes by Chamomilla. Chamomilla is particularly indicated in infants, when the miliaria is occasioned by keeping them too warm, and when it is accompanied with watery, greenish evacuations, looking like stirred eggs, and corroding the anus. Such an eruption in infants may be owing to dietetic transgressions, and may be attended with other symptoms for which Chamomilla is likewise a specific remedy. In cases where Chamomilla, although indicated, was of no avail, I have frequently given with the greatest benefit a very small dose of Sulphur, particularly when the eruption affected the inner surface of the thighs, the abdomen and nape of the neck, when the patients were very restless, and the thighs, sexual organs and anus looked like raw flesh. White miliaria is frequently cured by a single dose of Arsenic, unless the accompanying symptoms should indicate Valeriana, We ought to mention here another kind of eruption, pustules or wheals, with which infants with a flaccid skin are affected in hot weather, particularly when kept too warm. They are not accompanied with dangerous symptoms, and do not require the interference of art. Daily bathing and a diminution of the temperature are sufficient. If any medicine should be required, Aconite is generally the more suitable; and if the eruption should be very obstinate, Chamomilla and Bryonia: if the vesicles should be inflamed and suppurate, Dulc, Rhus t., Clematis, Ranunculus Sceleratus, etc., are indicated.

Chronic miliaria, which disappears in one place and re-appears in another, with much itching and burning, is most certainly removed by Mezereun, Clematis, Sar-saparilla, Staphysagria, Arsenicum, Ammon. carb., Sulphur, and Carb. veg.