Read Feb. 16, 1758.
ONE of the most natural effects of blistering plaisters, when applied to the human body, is to quicken the pulse, and increase the force of the circulation. This effect they produce, not only by means of the pain and inflammation they raise in the parts to which they are applied, but also because the finer particles of the cantharides, which enter the blood, render it more apt to stimulate the heart and vascular system.
The apprehension, that blisters must in every case accelerate the motion of the blood, seems to have been the reason, why some eminent physicians have been unwilling to use them in feverish and inflammatory disorders, till after the force of the disease was a good deal abated, and the pulse beginning to sink. However, an attentive observation of the effects, which follow the application of blisters in those diseases, will shew, that instead of increasing, they often remarkably lessen the frequency of the pulse. This I had occasion formerly to take notice of[31], and shall now evince more fully by the following cases.
I. A widow lady, aged about 50, was seized (December 1755) with a bad cough, oppression about her stomach and breast, and a pain in her right side, tho’ not very acute. Her pulse being quick, and skin hot, some blood was taken away, which was a good deal sizy: attenuating and expectorating medicines were also prescribed. But as her complaints did not yield to these remedies, I was called on December 26th, after she had been ill about ten days; at which time her pulse beat from 96 to 100 times in a minute, but was not fuller than natural. I ordered her to lose seven or eight ounces more of blood, which, like the former, was sizy; and next day, finding no abatement of her complaints, I advised a blister 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 two 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 four days; after which I ordered a large blister to be put between her shoulders. When this plaister 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.
II. 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 Russell, surgeon-apothecary in this place. On the 12th of February, after he had been ill above a fortnight, I 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 I 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 nine or ten days, gradually wasting, with continued sweats, and a great spitting of a thick mucus. During this time he used tinctura rosarum, and the mixture with gum. ammon. and acet. scillit. without any sensible benefit, and had six ounces 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 two or three 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 tinctura rosarum and the mixture with gum. ammon. and acet. scillit. and at present he enjoys good health.
III. 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. I 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 I 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, November 11th, which somewhat lowered her pulse, and lessened the shortness of breathing and quantity of phlegm in her lungs. November 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 third 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 beat now only 104 times in a minute. After this, her cough and spitting increasing again, she had, on the 20th of December, a fourth blister applied to her back, which, like the former, did her great service. Her stomach being extremely delicate, I scarce ordered any medicines for her all this time, except a cordial julep, with spir. volat. oleos. tincture of rhubarb as a laxative, and a julep of aqu. rosar. acet. vin. alb. and syr. balsam. of which last she took two table spoonfuls twice or thrice a day in a quarter of a pint of lintseed tea. After the fourth blister, she drank for some time a cupful of infusum amarum twice a day, and continued to recover slowly: and tho’ 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 is now in her ordinary health.
IV. 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 twelvemonth: and after getting, by proper remedies, in a good measure free from those complaints, her cough, from catching 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 seven or eight days in this condition, she was admitted into the Royal Infirmary, January 9th, 1757. As her pulse was small, tho’ very quick, viz. beating 130 in a minute, I thought it unnecessary to bleed her, as from former experience I did not doubt but that blistering alone would relieve her: I ordered, therefore, a large blister to be applied to her left side, where she complained of pain, and prescribed for her the following julep:
℞ Aqu. menth. simp. spirit. Minderer. ana ℥ iij. acet. scillit. ℥ i. sacchar. alb. ℥ ij. misce; 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 somewhat 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, I ordered her the following anodyne draught: