TREATMENT OF INFLAMMATION. 75 



of thoracic inflammation, for instance, wliere thousands of prac- 

 titioners employ blistering as a matter of course, the unsurpassed 

 authority of Professor Skoda pronounces such treatment to be 

 always powerless for good, though sometimes powerful for harm. 

 And probably a large proportion of treatment by long-continued 

 setons and issues has subsisted, less from any sure knowledge of 

 its doins: good, than as a remnant of the old belief that morbid 

 humours could thus be set running from the body. Assuredly 

 the whole subject requires careful clinical reconsideration; 

 towards which, in this place, only two suggestions are offered. 



" In the first place, particularly with regard to the uses of 

 blistering, there is a source of fallacy against which the student 

 will do well to guard himself. Not every cutaneous inflamma- 

 tion excited for surgical purposes is intended to be counter- 

 irritant and derivative. There are cases (presently to be again 

 adverted to) where it acts simply as a further stimulant to the 

 part originally inflamed. When, for instance, we apply strong 

 blistering fluid directly over a knee-joint with chronic inflam- 

 matory effusion, the action of the irritant propagates itself, in 

 lessening degrees, through the intervening small thickness of 

 parts, and sensibly affects the synovial surface ; where frequently 

 at first it causes some increase of effusion ; and where at any 

 rate the desired removal of fluid only begins when the super- 

 induced excitement has begun to subside. And it is by reason 

 of this action that, with regard to superficial parts, blistering, 

 if it does not resolve the inflammation, commonly determines 

 them to suppurate ; a fact, sometimes illustrated in the treat- 

 ment of indolent inguinal buboes, where it may happen that 

 blistering is deliberately used in order to force this alternative 

 on the part, and, either by one way or the other, to bring the 

 inflammation to a close. 



" Similarly, we may sometimes be proceeding rather too 

 drastically when we blister the walls of the visceral cavities. I 

 have often seen cerebral distress appear to be much aggravated 

 by the application of a blister to the scalp ; and it has happened, 

 in making the post mcn^tem examination of a patient to whose 

 abdomen a blister had been applied, to find on the inner surface 

 of the abdominal wall a red patch (probably of more injected 

 muscular substance seen through the peritoneum) corresponding 

 to the area of blistered skin. 



