Philosophical transactions, Vol. L. Part II. For the year 1758. / Giving some account of the present undertakings, studies, and labours, of the ingenious, in many considerable parts of the world.

by Various; Royal Society

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, tho’ seldom able to compleat 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 are 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 greatest service in internal ulcers.

In what manner blisters may lessen the fever and frequency of the pulse attending internal inflammations, I have elsewhere endeavoured to explain[32]; and shall only add 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 may 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[33], are less so in true peripneumonies. This difference, I imagine, may 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 than in the lungs, which have nerves from the eighth pair, and from the intercostals improperly so called.

Edinburgh, May 23d, 1757.

Extract of a Letter from Dr. Whytt, Professor of Medicine in the University of Edinburgh, and F. R. S. to Dr. Pringle, F.R.S.

Edinburgh, 10 Nov. 1757.

WHAT you remark with regard to blisters being freely used by the physicians at London, in the cases mentioned in the paper I last sent you, is very just, and indeed what I knew; but altho’ their efficacy in such circumstances is now generally acknowleged both in England and Scotland, yet I do not remember that their remarkable quality in lessening the quickness of the pulse has been particularly attended to. This, therefore, I thought it might not be amiss to ascertain by a few careful observations.

I agree intirely with you, as to the use of blisters in fevers; being of opinion, that when there is no particular part obstructed or inflamed, they are of little service, and sometimes hurtful, unless perhaps towards the end, when the pulse begins to sink. Nay, in fevers, where the substance of the brain is affected, and not its membranes, I have never found any sensible benefit from blisters: and I always suspect the brain itself affected, when a fever and delirium come on without any preceding head-ach, or redness in the tunica albuginea of the eyes. This kind of fever I have met with several times, and have observed it to be generally fatal.

LXXVI. A remarkable Instance of Four rough Stones, that were discovered in an 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. and Surgeon to Guy’s-Hospital.

Read Feb. 23, 1758.