642 SPOKADIC DISEASES. 



water seems to diminish the amount of exudation, and modify 

 the fibrinous condition of the blood. It has also a cooling 

 or detergent effect upon the system generally, modifying the 

 pyrexia, and, by acting upon the kidneys, assists in the excre- 

 tion of effete materials from the blood. In some instances, 

 particularly when the kidneys remain torpid, its diuretic effect is 

 increased by a few doses of colchicum. But the administration 

 of the nitre or the colchicum should not be persevered in too 

 long, as they both tend to debilitate, and whenever free diuresis 

 is established, they should be discontinued. In some instances, 

 particularly if the patient be debilitated or ou.t of condition, 

 spirits of nitrous ether may be substituted for the potash salt. 



Blisters. — For many years I have held that the application of 

 the so-called counter-irritants, whether they be cantharidine 

 blisters, mustard, turpentine, or any other powerful irritant, is 

 not only useless but dangerous in the earlier stages, and uncalled 

 for when convalescence is progressing favourably. 



In the earlier stages, they add to the distress, prevent the 

 freedom of the respiratory movements, and increase both the 

 fever and fibrinous condition of the blood ; and large cantharides 

 blisters, the cantharidine of which is absorbed into the blood, 

 induce a condition of blood poisoning characterised by albumi- 

 nuria and great prostration, and by irritating the urinary pas- 

 sages increase both the distress and the fever. I am glad to 

 find that this conclusion — a conclusion, I may state, which has 

 met with much opposition — is endorsed by physicians. Dr. 

 Wilson Eox says — " Blisters, in the earlier stages of pneumonia, 

 are to be considered as both useless and as greatly increasing 

 the distress of the patient. When resolution is progressing 

 favourably, they also appear to be quite unnecessary. In a few 

 cases when resolution is delayed, or when there is evidence of a 

 small amount of pleuritic effusion, they may, I believe, in adults 

 be occasionally employed with apparent advantage. In children 

 they are almost invariably inapplicable. Warm fomentations or 

 poultices to the sides often give great relief to the pain. I have 

 by no means satisfied myself that any advantage accrues during 

 the acuter stages from any more irritant applications, whether 

 mustard or turpentine, though in cases of threatening collapse, or 

 when dyspnoea is severe, they have occasionally appeared to 

 afford relief." — (See Eeynolds' System of Medicine, vol. iii., p. 701.) 



