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to be applied in the evening, to that part of her right side which was pained. Next morning, when the blister was removed, the pain of her side was gone, and her pulse beat only 88 times in a minute, and in 2 days more it came down to 78. However, after the blistered part became dry, the pulse rose in one day's time to 96, and continued between that number and 90 for 4 days: after which he ordered a large blister to be put between her shoulders. When this plaster was taken off, her pulse beat under 90 times in a minute; and next day it fell to 76, and the day after to 72. The cough and other symptoms, which were relieved by the first blister, were quite cured by the second.
2. John Graham, bookbinder, in Edinburgh, aged 37, of a thin habit of body, formerly subject to coughs, and thought to be in danger of a phthisis pulmonalis, having exposed himself unwarily to cold in the night time, was, about the end of January 1756, seized with a bad cough and feverishness; for which he was blooded, and had a diaphoretic julep, a pectoral decoction, and a mixture with gum ammoniacum, and acetum scilliticum, given him by Mr. James Russel, surgeon-apothecary in this place. On the 12th of February, after he had been ill above a fortnight, Dr. W. was desired to visit him. He seemed to be a good deal emaciated; his eyes were hollow, and cheeks fallen in : he was almost constantly in a sweat; coughed frequently, and spit up a great quantity of tough phlegm, somewhat resembling pus: his pulse beat from 112 to 116 times in a minute. In this condition he ordered immediately a blister to be applied between his shoulders, which lessened in some degree his cough and spitting, as well as the frequency of his pulse; but the blistered part no sooner began to heal, than he became as ill as before, and continued in this bad way 9 or 10 days, gradually wasting, with continued sweats, and a great spitting of a thick mucus. During this time he used tinct. ros. and the mixture with gum. ammon. and acet. scill. without any sensible benefit, and had 6 oz. of blood taken away, which was very watery, and the crassamentum was of a lax texture. In this almost desperate condition, another blister larger than the former was put between his shoulders, which remarkably lessened his cough and spitting, and in 2 or 3 days reduced his pulse to 96 strokes in a minute. After this he continued to recover slowly, without the assistance of any other medicine, except the tinct. ros. and the mixture with gum. ammon. and acet. scill. and he then enjoyed good health.
3. Mrs. , aged upwards of 40, who had for several years been subject to a cough and spitting in the winter months, was in October 1756, seized with those complaints in a much greater degree than usual; to remove which she was blooded, and got some attenuating and pectoral medicines from Mr. John Balfour, surgeon-apothecary in Leith. Dr. W. was called on November 11th, after she had been ill several weeks, and found her in a very unpromising
condition. She had a frequent and severe cough, with great shortness of breath and a wheezing; her lungs seemed to be quite stuffed with phlegm, of which she spit a vast quantity every day, and of such an appearance, that Dr. W. was apprehensive it was, in part at least truly purulent. When she sat up in a chair, her pulse beat above 130 times in a minute. She had a considerable thirst, and her tongue was of a deep red colour, with a beginning aphthous crust on some parts of it. She was so weak and her pulse so feeble, that there was no place for further bleeding: a blister was therefore applied to her back, Nov. 11th, which somewhat lowered her pulse, and lessened the shortness of breathing and quantity of phlegm in her lungs. Nov. 16th, a second blister was laid to her side, which gave her still more sensible relief than the former, and reduced her pulse to 114 strokes in a minute. November 25th, a 3d blister was applied to her back; by which her cough and wheezing were rendered considerably easier, and the phlegm which she spit up, lost its purulent appearance, became thinner, more frothy, and was much less in quantity. Her pulse then beat only 104 times in a minute. After this her cough and spitting increasing again, she had on the 20th of Dec. a 4th blister applied to her back, which, like the former, did her great service. Her stomach being extremely delicate, he scarcely ordered medicines for her all this time, except a cordial julep, with spir. volat. oleos. tinct. of rhubarb as a laxative, and a julep of aqu. rosar. acet. vin alb. and syr. bals. of which last she took 2 table spoonfuls 2ce or 3ce a day in 4 of a pint of lintseed tea. After the 4th blister, she drank for some time a cupful of infusum amarum 2ce a day, and continued to recover slowly: and though during the remaining part of the winter she was as usually, a good deal troubled with a cough, yet in the spring she got free from it and recovered her ordinary health.
4. Christian Mcewen, aged 21, had laboured under a cough, thick spitting, pain of her breast, and pains in her sides affecting her breathing for about a 12 month: and after getting by proper remedies, in a good measure free from those complaints, her cough from taking a fresh cold, increased to a greater degree than ever, became hard and dry, and was attended with a constant difficulty of breathing, pain in her left side, and head-ach. After having been 7 or 8 days in this condition, she was admitted into the Royal Infirmary, January 9th, 1757. As her pulse was small, though very quick, viz. beating 130 in a minute, he thought it unnecessary to bleed her, as from former experience he did not doubt but that blistering alone would relieve her: he therefore ordered a large blister to be applied to her left side, where she complained of pain, and prescribed for her the following julep:
R Aq. menth simp. sp. Mind. ana 3 iij. acet. scill. i. sacch. alb. zij. M. Cap. coch. ij. ter in die.
She was also desired to breathe frequently over the steam of hot water, and to drink lintseed tea.
January 10th. Her pulse beat only 112 times in a minute, and was somes what fuller than on the 9th. The blister was not removed till late in the evening, and made a plentiful discharge. The cough having been so severe last night, as to keep her from sleep, he ordered her the following anodyne draught:
R Sp. Mind. 3 ss. acet. scill. 3i. syr. papav. alb. 3 vi. M. cap. hor. somni. Jan 11th. The cough easier last night; difficulty of breathing less; pulse 108 in a minute. Ordered the anodyne draught to be repeated, and the use of the julep, with acet. scill. to be continued. Jan. 12th. Pulse slower'; cough and pain of the side easier; but still complained of a head-ache. Jan. 13th. Pulse 94 in a minute; cough continued easier in the night, but was troublesome in the day-time. Jan. 14th. Every way better; pulse only 80 in a minute. As her cough was still bound, he ordered her, besides the medicines abovementioned, a pectoral decoction of rad. alth. &c. Jan. 15th. Cough and other complaints in a great measure removed: pulse 65 in a minute.
From this time her cough gave her little trouble; but on the 18th, she complained of a pain in the epigastrium, with sickness at stomach, want of appetite, and a giddiness in her head, which were considerably relieved by a vomit, infus. amar. and stomachic purges; and were almost wholly cured by the return of her menses, on the 5th of Feb. after an interval of 8 weeks.
5. A girl 21 months old, who had (Dec. 1756) a great load of the small-pox, and not of a good kind, with a cough and obstructed breathing, was, on the 7th day from the eruption, blistered on the back; by which the pulse was lessened from 200 to 156 strokes in a minute. Next day her legs were also blistered, and the pulse thereby fell to 136. But the child's lungs being much oppressed, and her throat being so full of pustules that she could scarcely swallow any thing, she died towards the end of the 9th day.
Dr. W. could have added several other cases of the remarkable effects of blisters in lessening the quickness of the pulse in coughs attended with fever, pain in the side, and pituitous infarction of the lungs: but those above seemed sufficient to put this matter' out of doubt, as well as to remove any prejudice that might remain against the free use of so efficacious a remedy.
In a true peripneumony, especially where the inflammation is great, repeated bleeding is the principal remedy, and blisters early applied are not so proper. But when the peripneumony is of a mixed kind; when the lungs are not so much inflamed as loaded with a pituitous matter; when bleeding gives but little relief; when the pulse, though quick is small; when the patient is little able to bear evacuations, and the disease has continued for a considerable time; in all
these cases blistering will produce remarkably good effects, and far from increasing, will generally lessen the frequency of the pulse and fever, more speedily than any other remedy.
On the other hand, when the fever and frequency of the pulse proceed from a true inflammation of the lungs, from large obstructions tending to suppuration, or from an open ulcer in them, blisters will be of less use, nay sometimes will do harm except in the last case, where they, as well as issues and setons are often beneficial, though seldom able to complete a cure. But as in pituitous infarctions of the lungs, with cough and fever, repeated blisters applied to the back and sides are far preferable to issues or setons, so these last seem most proper in an open ulcer of the lungs. The former make a greater and more sudden derivation, and are therefore adapted to acute cases; the latter act more slowly, but for a much longer time, and ate therefore best suited to chronic diseases. Further, while blisters evacuate chiefly the serous humours, issues and setons generally discharge true purulent matter, and on this account may be of greater
service in internal ulcers.
In what manner blisters may lessen the fever and frequency of the pulse attending internal inflammations, Dr. W. had endeavoured to explain in his Physiological Essays, p. 69; and only adds here, that in the cases above recited, where the quick pulse and feverishness proceeded more from a pituitous infarction than a true inflammation of the lungs, blisters, by relieving this organ in some measure of the load of humours oppressing it, would render the circulation through its vessels freer, and consequently lessen the quickness of the pulse, and other feverish symptoms.
It might not, however, be improper briefly to point out the reason, why blisters which have been observed to be remarkably efficacious, even when early applied in pleurisies, are less so in true peripneumonies. This difference he imagined might be accounted for from there being no immediate communication between the pulmonary vessels and those of the sides and back, to which the blisters are applied; whereas the pleura and intercostal muscles are furnished with blood-vessels from the intercostal arteries, which also supply the teguments of the thorax so that while a greater flow of serous humours, and also indeed of red blood, is derived into the vessels of the external parts to which the vesicatories are applied, the force of the fluids in the vessels of the inflamed pleura, or intercostal muscles must be considerably lessened. Further, as the intercostal muscles and pleura are, as well as the teguments of the thorax, supplied with nerves from the true intercostals, blisters applied to the back and sides may perhaps, on this account, also have a greater effect in relieving inflammations there
* Dr. Pringle's Observations on the Diseases of the Army, part iii, chap. 2.
than in the lungs, which have nerves from the 8th pair, and from the intercostals improperly so called.
LXXVI. A remarkable Instance of Four Rough Stones, discovered in a Human Urinary Bladder, contrary to the received Opinion; and Successfully Extracted by the Lateral Method of Cutting for the Stone. By Mr. Joseph Warner, F. R. S. p. 579.
[Reprinted in this author's work, entitled Cases in Surgery, to which the chirurgical practitioner is referred.]
LXXVII. Observations on the Limax non cochleata Purpur ferens, the naked Snail producing Purple. By J. A. Peyssonel, M. D., F. R. S. Translated from the French. p. 585.
Among the fish met with in the seas of the Antilles of America, this, here described, appears precious from the beautiful purple colour it produces, in the same manner that the cuttle-fish produces its ink, if means could be found to procure this liquor in a sufficient quantity to render it an article of commerce. These fishes are soft, viscous, without shells, scales, or bones; are of the nature of the polypi, and such other kinds, without feet, fins, or any thing to supply their places. Their motion is vermicular; and like the slugs they wreath themselves up, and when touched make themselves quite round. They fill up certain membranes of the body with water. Their local motion, antennæ, which they lengthen and contract; and a great many other properties which they have in common with snails, slugs, and turbinated shell-fish, made Dr. P. call them naked snails: and though they have not the most essential qualities of snails, he thought he might give them the name, as they have no particular appellation in this country. Some call them piss-a-beds, some sea cats, and others a less modest name, tapecon, taken from Pliny.
This fish is commonly 4 inches long, and a thick; of a greenish colour, spotted with black, each of which forms a circle. The under part is like that of snails, flat, with kinds of mamillæ, or rugosities, which are adhesive; by means of which they advance in a vermicular motion; and when touched become round, by retracting their neck and head; and afterwards protrude them considerably, according to their motion and progression, crawling upon rocks to seek their food. The head of this animal has a flatness, or is inclinable to a square or parallelogram. On each side there are membranes of skins, which form kinds of ears; and under them others, which at times fill with water, and are then transparent. Under this thick skin there is a cranium, of a kind of * The animal here described seems to be a species of aplysia.